Thursday, April 14, 2011

MRSA Reduction Makes Front Page of NYTimes

“The study of 153 Veterans Affairs hospitals nationwide found a 62 percent drop in the rate of infections caused by methicillin-resistant Staphylococcus aureus, or MRSA, in intensive care units over a 32-month period. There was a 45 percent drop in MRSA prevalence in other hospital wards, like surgical and rehabilitation units.

The Veterans Affairs strategy employs a “bundle” of measures that include screening all patients with nasal swabs, isolating those who test positive for MRSA, requiring that staff treating those patients wear gloves and gowns and take other contact precautions and encouraging rigorous hand washing. The results may not be easily replicated in the private sector, but they are likely to step up pressure by further undercutting the notion, prevalent at many hospitals not long ago, that infections are an unavoidable cost of doing business.”

Full Article

Wednesday, December 22, 2010

CDC Offers Guidance on Evaluation of Environmental Cleaning

The Centers for Disease Control and Prevention (CDC) has released guidance for programs to optimize the thoroughness of cleaning of high-touch surfaces. The guidance recommends a two-level program administered by infection preventionists and coordinated and maintained through environmental services professionals.

The document, “Options for Evaluating Environmental Cleaning,” was prepared by Alice Guh, MD, MPH, of the Division of Healthcare Quality Promotion in the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, and Philip Carling, MD, of Carney Hospital and Boston University School of Medicine in Boston. Assistance in document preparation was provided by Brian Koll of Beth Israel Medical Center in New York; Marion Kainer and Ellen Borchers from the Tennessee Department of Health in Nashville, Tenn.; and Brandi Jordan of the Illinois Department of Public Health in Chicago.
The document notes, “In view of the evidence that transmission of many healthcare-acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high-touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients. Since dedicated resources to implement objective monitoring programs may need to be developed, hospitals can initially implement a basic or Level I program, the elements of which are outlined below. Some hospitals should consider implementing the advanced or Level II program from the start, particularly those with increased rates of infection caused by healthcare acquired pathogens (e.g., high Clostridium difficile infection rate). All hospitals that have successfully achieved a Level I program should advance to Level II.”

The document continues, “At present, the objective monitoring of the cleaning process of certain high touch surfaces (e.g., the curtain that separates patient beds) beyond those outlined in the attached checklist is not well defined. Additionally, there is no standard method for measuring actual cleanliness of surfaces or the achievement of certain cleaning parameters (e.g., adequate contact time of disinfectant) or for defining the level of microbial contamination that correlates with good or poor environmental hygienic practices. As our understanding of these issues evolve and a standardization of assessment in these respective areas can be developed and practically implemented, hospitals that have obtained a high compliance rate with surface cleaning as outlined in the Level II program are encouraged to advance their efforts in optimizing environmental hygienic practices.”

Link to Environmental Cleaning Guidelines

Friday, November 5, 2010

Some thoughts about MRSA prevention & hospital care from a patient’s perspective

Not too long ago, in my role as a health project manager, I became interested in the concept of promoting family involvement to assure better MRSA hygiene practices. I became convinced family members could be an effective extension of the health care team to reinforce good hygiene practice in hospitals.

But now I really am convinced. But now I’m able to come at the same questions from a patient perspective. And as a patient, I’m convinced all patient’s need an advocate.

I was recently an ER patient in one of our participating MRSA study hospital. The care was excellent and I was treated very well. When I was able to pay attention, I think the MRSA preventive hygiene practices were done consistently.

The truth was, however, I was NOT able to pay attention most of the time. During my stay, I was poked and prodded and handled by very courteous health care workers who reassured me this test or that IV in my arm was needed…and they just wanted to rule out anything really serious…and as it turned out they were right.

The hospital experience was a little overwhelming, however. I could not help but feel slightly disoriented. I was unable to relax and might have thought a bit too much about how much this was going to cost.

BUT theory, I was an informed, fully insured consumer.

My day job has me keeping track of MRSA statistics and reading about good MRSA preventive protocols. But being a patient is far more difficult. You’re walking or riding into a live action scene. It’s not like a shopping trip where you can just leave and decide not to buy that TV. You may not be able to walk away. The latest consumer report best buy guide doesn’t cover this situation. You are not in control. It can be intimidating.

When I’m asked about my job, I frequently say to my friends that I will never look at a bed rail the same way… many hands have touched it……and then they might be touching me…. but that day, I didn’t give it much thought.

And when I was being rolled around the halls going to and from the numerous diagnostic tests…in my designer “Johnny gown”… I was glad to be rolling smoothly in my open air hospital limousine…with bed rails. Truth is, I was not anxious to walk down the hall in my open air gown. It was more comfortable to count the ceiling tiles and lights. MRSA prevention was not on my mind. There was no sign on my door warning anyone “unclean” to stay out.

Here I am with all this knowledge about proper patient hygiene procedures and MRSA infection rates at the tip of my tongue, but the best I could do was be an educated passive observer.

So now, when I hear about or read about gutsy patients or family members who DO get involved and put up their own “keep away / reminder” signs….I admire them more….and applaud…..and keep on applauding for the hospital staff that encourages such behavior. I appreciate how brave and confident a patient or a family member needs to be to play policeman or challenge medical authority figures. I also appreciate how confident and dedicated a nursing staff must be to support those families and patients.

My take away message is simple. Patients are inherently vulnerable.

So my advice is to take your mother (or someone like her ) with you to the hospital. Get a personal advocate. She will ask the questions you forget to ask or were afraid to. She will make the sign warning away unclean workers. And she will record questions in a notebook to ask the doctor later. She knows you have a lot on your mind. She’s on your team

She may not have professional training, but she will know that one hospital acquired infection is too many if it could be prevented. She will also know the convenience of any healthcare worker is not a good excuse for failing to take proper precautions.

“Did you wash your hands young man? You can’t come to the dinner table until you do.”

Welcome to the team Mom!

Joe Poisson PMP
Health Information Project Manager

Thursday, September 9, 2010

Congratulations to the Community North Progressive Care Unit!

From the Community Health Care Network Newsletter:

"The North Progressive Care Unit has now gone two years without a nosocomial MRSA infection. There is no national benchmark to compare our results with but the unit had never gone more than a quarter at a time without an infection prior to the Implementation of the MRSA bundle. This bundle consists of increased compliance with hand hygiene, proper usage of personal protective equipment (contact precautions), screening all patients admitted to the unit and isolating positives right away and increased compliance with cleaning of high touch surfaces. The implementation and ownership of this bundle of practice by staff is a great safety success story."

Monday, August 30, 2010

New Hand Washing Sign for Community

Loretta shared with me this fantastic new sign at Community. Notice there's a large section of the bottom that's blank. That's for staff, nurses, and providers to sign their names signifying their commitments.

-We commit that every time
we enter or exit a patient room
or treatment area, we will wash
our hands.

-We will hold one another
accountable for performing
hand hygiene.

-We will respond graciously by
saying “thank you” when we’re
reminded to wash our hands.