Download Carilion New River Valley Medical Center, VA, CDI

AHA/HRET HEN 2.0
STORYBOARDS
>>
ORGANIZATION AND TEAM
CARILION NEW RIVER VALLEY MEDICAL
CENTER CHRISTIANSBURG, VIRGINIA
PROJECT GOALS
IMPROVEMENT STRATEGY
Reduce Clostridium difficile (C. diff) through a regional and collaborative
approach because:
Engage leadership:
>> We identified an increase in the number of patients with C. diff
coming from long term care (LTC) facilities.
++ We realized that many patients receive health care at both acute
care and LTC facilities.
Cross continuum approach
>> Facilities can’t prevent C. diff and multi-drug resistant organisms
(MDRO) in their community alone.
>> By expanding epidemiology programs throughout the continuum
of care, we can explore new prevention opportunities to reduce the
patient’s susceptibility and risk of exposure.
++ C. diff can spread when patients are transferred among facilities
who do not follow precautions.
THE NEW RIVER CROSS SETTING COUNCIL INCLUDES FOLLOWING FACILITIES
>> Share facility data showing that all patients were symptomatic
on admission as well as the high rate of antibiotic use among
LTC residents.
>> Discuss the financial impact of the upcoming C. diff LabID reporting
requirement and that infections and antibiotic use in one facility
affect the other facilities due to patient transfers.
Educate all levels of staff!
>> First education focus:
++ Evidence-based education focusing on C. diff and role
of antibiotics.
>> Second education focus:
++ Education for LTC employees which included booths with
handwashing validated, PPE donning and doffing competency,
MDROs and C.diff.
AND AGENCIES:
Carilion New River Valley Medical Center
Carilion Giles Community Hospital
LewisGale Montgomery Regional
LewisGale Pulaski Community Hospital
Virginia Department of Health
>> Share national data: cost per C. diff infection, increased LOS,
mortality rate and prevalence.
Virginia Healthcare Quality (VHQC)
Agency on Aging
Carilion Home Care, and 14 LTC facilities
in the NRV
>> Third education focus:
++ Two infection control conferences for nurses: DON
and administrators.
>>
RESULTS
CARILION RESULTS
>> This successful collaboration has led to leaders thinking beyond our doors.
>> We use the continuum of care model to begin discussion about other
topics such as medication lists transferred between facilities and handoffs.
>> The Association for Professionals in Infection Control and
Epidemiology – Virginia chapter (APIC-VA) appointed a LTC liaison
to their board.
>> The Virginia Department of Public Health, Virginia Hospital and Health
Care Association, Virginia Health Quality Center and APIC-VA created
an ongoing effort to establish collaboratives across the state.
CNRV # C. diff Cases, Jan. 2008 – Dec. 2014
Figure 1. Number of C. diff cases
in 4 acute care hospitals in the
New River Cross Setting Council
Figure 2. C. Diff SIR, Virginia 2014–2015:
shows the regional C. Diff SIR compared to
the rest of the state.
LESSONS LEARNED: PARTNERING
WITH LTC
90
>> Make it easy for LTC facilities to attend meetings. Consider their
needs when scheduling meetings.
CDI cases
CDI HAI
80
>> Gain acceptance of LTC personnel to have outsiders come into their
facilities by tailoring the education program towards the needs of the
LTC facilities.
70
60
>> Turnover rates among administration and frontline workers are high at
LTC facilities.
50
++ Maintain a current roster in order to keep the facility engaged.
40
++ Plan for ongoing “road trips” to bring education to the new hires.
30
>> To offset the costs of conferences make contacts with organizations
such as your local emergency management, pharmaceutical
companies, QIOs, etc.
180
20
total LABID
160
healthcare onset
140
10
120
100
0
80
2008
2009
2010
2011
2012
2013
2014
>> Keep in mind that the knowledge base of LTC personnel varies from
that of acute care personnel.
60
40
20
0
2011
2012
2013
Virginia and Maryland CDI SIR Map (Q2–2014 to Q1–2015)
LESSONS LEARNED
SUSTAINABILITY AND SPREAD
TOOLS, RESOURCES, POLICIES, TIPS
TEAM MEETINGS
>> Continually assess whether the meetings are made up of the
appropriate individuals.
>> Sustainability has been achieved:
>> www.cdc.gov/vitalsigns/pdf/2015-08-vitalsigns.pdf
++ Encourage new and innovative ideas of individuals.
>> Discuss ways to keep the team motivated, engaged and effective.
>> Discuss flexibility of the group — add ad hoc members as needed.
++ The DON, administrators and nurses in LTC facilities have a better
understanding of antibiotic use and aren’t requesting antibiotics as
quickly as in the past.
• Medical directors intervene when these medications
are prescribed.
>> Friedman C. et al Requirements for infrastructure and essential
activities of Infection Prevention and Control and epidemiology in
out-of-hospital settings: A Consensus Panel report AJIC: American
Journal of Infection prevention and Control (1999;27:418-30).
>> http://www.cdc.gov/drugresistance/resources/publications.html.
>> Provide prompt follow-up and follow through.
++ This initiative has promoted communication between LTC facilities,
acute care and other agencies.
>> A video of the model simulations is available at http://www.cdc.gov/
drugresistance/resources/videos.html.
STRATEGY
>> Coordinate prevention approaches coupled with intensified facilitybased prevention programs, has the potential to address the
emergence and dissemination of these organisms comprehensively.
++ Consistent education about C. diff, and evidence-based prevention
strategies are being utilized across the continuum of care.
>> http://www.cdc.gov/hai/prevent/tap.html.
>> There is a need for greater understanding and implementation
of basic infection prevention guidelines as well as surveillance
techniques to detect significant community-associated or
healthcare-associated events.
>> Information about MDROs, C. diff, immunization, and infections is
vital to patient placement.
>> The Virginia HAI Advisory Committee is currently discussing
transition of care and transfers where these achievements have
been highlighted.
>> The Virginia Department of Health has highlighted these
achievements in their statewide newsletter.
>> We have not officially hardwired the intervention, but have opened
the doors of communication across the continuum of care so we are
all part of the patient experience rather than individual silos.