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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.