Transcript The Vermont Multidrug-Resistant Organism Healthcare-Associated Infection Prevention Collaborative

The Vermont
Multidrug-Resistant Organism
Healthcare-Associated Infection
Prevention Collaborative
A Hospital and
Long Term Care Facility
Partnership:
Overview of Our 1st Year
Sally Hess, MPH, CIC
FAHC, Infection Prevention Manager
Carol Wood-Koob RN, CIC
HAI Prevention Coordinator
Patsy Tassler Kelso, Ph.D
State Epidemiologist for Infectious Disease
Presentation Outline
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History of the project
Description of the collaborative approach
Review of successes and challenges
Focus on the “Burlington Cluster”
Background
 Healthcare-associated infections (HAIs) are a
significant cause of morbidity and mortality in the
US.
 1.7 million infections/year
 99,000 deaths/year
 HAIs are the most common cause of adverse
events in healthcare with direct medical costs
$35 – 45 billion (adjusted for 2007 inflation).
 Impact of infections in long-term care –
Unknown?
History
 ARRA funding provided CDC support for
state health departments in HAI prevention.
 VDH, VPQHC, and BISHCA collaborated
on Vermont’s proposal.
 Vermont 1st state to publicly report infection
rates using the National Healthcare Safety
Network (NHSN).
 Vermont 4th state to report hospital-specific
rates.
History (continued)
 ARRA grant supported:
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HAI Prevention Coordinator at VDH
Development of state plan for HAI prevention
NHSN data validation
HAI prevention collaborative
Vermont’s Collaborative
Vision
For acute and long-term care facilities to
work together toward the prevention and
elimination of healthcare-associated
infections.
CDC Called…
 John Jernigan – your inclusion of longterm care in HAI prevention is the way to
go! Why don’t you
 Focus on multidrug-resistant organisms
(MDRO)
 Submit MDRO data electronically to CDC
 CDC will provide help from WHONET for
electronic reporting from hospital labs.
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What is a MDRO?
Bacteria resistant to certain groups of antibiotics
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Methicillin-Resistant Staphylococcus aureus (MRSA)
Vancomycin-Resistant Enterococcus spp. (VRE)
Cephalosporin-Resistant Klebsiella spp.(CephR-Klebsiella)
Carbapenem-Resistant (CRE) Klebsiella spp.
Carbapenem-Resistant (CRE) E coli.
Multidrug-Resistant (MDR) Acinetobacter spp.
What is a Healthcare Cluster?
Hospitals and long-term care facilities serving the
same community, working together to form a larger
team.
Hospital
(H)
LongTerm
Care
(L)
10
(L)
Healthcare
(H) Cluster
Team (L)
(L)
Collaborative
Hospitals:
• 13 in VT
• 1 in NH
Collaborative
LTC Facilities:
• 40 in VT
Patient/Resident
Transfers as
Reported by
Facilities
Healthcare Clusters
 Geographically local groups of acute
and long-term care facilities
 Share patients and laboratory
 Group decision-making about what
interventions will work for them
 Peer to peer learning and support
MDRO PreventionThe CDC Challenge
 Innovative interventions to prevent and control
MDROs
 Communication between facilities
 Modified contact precautions
 Environmental cleaning
 Hand hygiene education, observations
 Antimicrobial stewardship
 Chlorhexidine (CHG) use
 Promoting good urinary catheter practices
Learning Sessions
 September 2010
 January, May, September 2011
 Full-day meetings included:
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CDC speakers
Vermont subject matter experts
NHSN guidance
Updates from clusters and facilities
Assessment of Infection Control
Programs in LTC - Baseline
 A CDC survey was used to assess Infection
Control (IC) programs in LTC.
 Characteristics of person responsible for IC
program:
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RN’s – 71% (22/31)
Certified in Infection Control – 0% (0/31)
No specific infection control training – 74% (23/31)
Coordination of infection control
 Full time – 10% (3/31)
 Part time – 90% (28/31)
Cluster & LTC “Coaching”
 Phone outreach by VDH and VPQ staff
 VDH and VPQ attending cluster
meetings
 Help with NHSN enrollment
 Resource material and educational
tools provided for LTCF
Collaborative Successes
 Enhanced knowledge of infection control “best
practices”
 Improved communication between facilities
 Sharing information, practices, policies & procedures
 Inter-facility transfer form
 Recognizing environmental services needs
 Physician involvement in cluster meetings and
discussions about interventions
Collaborative Successes (cont.)
 Implementation of enhanced standard
precautions
 MDRO patient/family educational information
 Active surveillance for MRSA
 Hand hygiene observations
 Clinical evaluation algorithm for suspected
urinary tract infection (UTI)
 Training on NHSN enrollment and event
identification
Collaborative Challenges
 Little control over environmental services
 Implementing changes in all facilities in a cluster
– not one-size-fits-all
 Different cultures / approaches to change
 Lack of engagement of facility administration
 Limited personnel resources / time
 Staff turnover
 Limited computer skills and access
Reporting MDRO “Events” to NHSN
 All 13 VT hospitals enrolled in NHSN
 ~ 20 LTC enrolled in NHSN
 WHONET is working with Vermont hospitals to
electronically transmit laboratory & ADT data
 One of the 1st in the nation to do this!
 8 hospitals sending data electronically so far
 NHSN is developing a new LTC component
 Vermont facilities are ahead of the rest of the U.S.
 In many clusters the hospital IP will report MDRO data for the
long-term care facilities
•Work Flow for LTCF LabID Events
1.
Lab data submitted electronically to WHONet by acute care (AC).
2.
WHONet to identify LabID Event candidates for AC and LTCF.
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MDRO Events
Lab data must include a unique identifier for each LTCF i.e.; location code
from
Event candidates identified using NHSN inclusion & exclusion criteria.
LTC…..using
WHONet Candidate
list – excel spreadsheet.
NHSN.
AC IP will filter the candidate list; specific to each LTCF in their
A Vision for the
cluster.
Future.
AC IP sends candidate list to the LTC IP.
FAX, secure file transfer, mail or other agreed upon HIPAA compliant method.
6.
LTC IP completes LabID event form for each candidate.
7.
Lab ID Event form & Monthly Monitoring forms sent to CDC (need
to get specifics from Nimalie on how this could be done).
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Moving Forward
 Ongoing cluster meetings
 LTCFs that aren’t participating in HAI
Collaborative can attend cluster meetings,
take advantage of collateral benefits (e.g.
transfer form, CHG bathing)
 Some clusters already going beyond scope
of HAI Collaborative
 Addressing other organisms
 Including additional stakeholders (EMTs)
 Monthly data transmission to NHSN
Moving Forward (continued)
 Implementing successful interventions across the state
 Additional learning sessions
 Subject matter experts (e.g., antibiotic stewardship)
 Change management skills training
 QIO support
 UVM student projects
 RN to BS Program
 Department of Medical Laboratory and Radiation Sciences
 Residential Care infection prevention training
Infection Preventionists Unite!
 VICPA
 Long-term care IPs invited to join
 First meeting of larger group in April 2011
 Joint VT/NH infection prevention
meeting September 2011
Sharing Vermont’s
Successes
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CDC Safe Healthcare Blog
CDC 2010 HAI Grantee Meeting
CDC 50-state conference call
2011 Council of State and Territorial
Epidemiologists Conference
 Many more to come…
Burlington Cluster
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Fletcher Allen
Vermont State Hospital
Birchwood Terrace Nursing Home
Burlington Health and Rehab Center
Green Mountain Nursing Center
Starr Farm Nursing Center
Wake Robin
MDRO Burlington Cluster Goals Identified at the last Vermont
Healthcare Infection MDRO Collaborative - Learning Session #3
Goal 1: Cleaning protocols are followed by housekeeping contractor on transfer and
discharge, and daily cleaning
 Measure: Surfaces will be audited 2-3 audits per week and protocol will be followed
90% of the time.
 To Do: Each facility will review the cleaning protocol for their facility. Need to develop
and audit form for each facility
 Follow-up: Facilities will provide feedback in a non-punitave way to their contractors
Goal 2: Chittenden cluster will be enrolled in NHSN by the next learning session.
 Measure: 100% enrolled
Goal 3: Standardize the transfer process to and from acute and long term care.
 Measure: Audit process for 2 transfers in or out each week completed per protocol
90% of the time
 To Do: Standardize transfer form, Finalize and implement workflow transfer process,
develop an audit form.
Goal 4: Fletcher Allen Health Care, in collaboration will develop an Infection Prevention
education program for LTC facilities
 Measure: Customer feedback surveys 90% satisfaction
 To Do: Presented at least once at each LTC facility before the next learning
session. Develop feedback survey
Accomplishments & Next Steps
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Evaluated current LTC and acute care practices re:
isolation & patient placement
Reviewed housekeeping practices
Created an environmental services checklist
Developed an inter-facility communication/transfer
form
Revised the current FAHC Transition of Care form to
include all key elements of the transfer form
Reviewed the California enhanced precautions
document – recommended changes to the State
Developed infection prevention curriculum &
presentation for annual LTC staff education
Accomplishments & Next Steps
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MRSA screening on admission to FAHC
CHG bathing on admission to FAHC
Successfully transmitted hospital MDRO and C. diff
data to NHSN via WHONET
Enrollment of LTC facilities in NHSN
NHSN MDRO LabID education
LTC MDRO and C. diff data to NHSN
LTC infection prevention open forum with Q&A
By demonstrating success as a region,
Vermont can serve as a model for MDRO prevention nationally.
John A. Jernigan MD MS (CDC/CCID/NCPDCID)
Deputy Chief, Prevention and Response Branch
Centers for Disease Control and Prevention