Clostridium-Difficile Reduction Utilizing an Interdepartmental Team Approach Mary Jane Lamb RN, IP
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Clostridium-Difficile Clostridium-Difficile Reduction Reduction Utilizing an Utilizing an Interdepartmental Team Interdepartmental Team Approach Approach Mary Jane Lamb RN, IP Mary Jane Lamb RN, IP
description
Clostridium-Difficile Reduction Utilizing an Interdepartmental Team Approach Mary Jane Lamb RN, IP. Objectives. Demonstrate how APIE was used to facilitate solving our problem Discuss how our team approach helped to improve care, reduce C-Diff #s and make staff happier - PowerPoint PPT Presentation
Transcript of Clostridium-Difficile Reduction Utilizing an Interdepartmental Team Approach Mary Jane Lamb RN, IP
Clostridium-Difficile Clostridium-Difficile ReductionReduction
Utilizing anUtilizing an
Interdepartmental Team Interdepartmental Team ApproachApproach
Mary Jane Lamb RN, IPMary Jane Lamb RN, IP
ObjectivesObjectives
Demonstrate how APIE was used to Demonstrate how APIE was used to facilitate solving our problemfacilitate solving our problem
Discuss how our team approach Discuss how our team approach helped to improve care, reduce C-helped to improve care, reduce C-Diff #s and make staff happierDiff #s and make staff happier
Discuss most recent changes to Discuss most recent changes to isolation and to lab testingisolation and to lab testing
APIEAPIE
AssessAssess PlanPlan InitiateInitiate EvaluateEvaluate
Assess ProblemAssess ProblemIdentify problemIdentify problem
Increase in cases -Increase in cases - 14 cases in 14 cases in 20072007
Assess ProblemAssess ProblemIdentify problemIdentify problem
Increase in cases - Increase in cases - 14 14 cases in 2007cases in 2007
18 CASES IN 2008 FROM JANUARY TO JUNE
Assess ProblemAssess ProblemIdentify problemIdentify problem
Increase in cases- 14 cases in 2007Increase in cases- 14 cases in 2007 18 cases in 2008 Jan – June18 cases in 2008 Jan – June
Time LineTime Line Indentify overlapping patientsIndentify overlapping patients Indentify primary departments involvedIndentify primary departments involved
Observe staff behaviorObserve staff behavior Not isolating until after diagnosisNot isolating until after diagnosis Sharing commodes/toiletsSharing commodes/toilets Carrying dirty laundry out of room to hamperCarrying dirty laundry out of room to hamper
PlanPlan
1.1. Target Zero Task Force – Target Zero Task Force – InterdepartmentalInterdepartmental
RNs, CNAs, Education staff, RNs, CNAs, Education staff, and and Environmental staffEnvironmental staff
22. Review Policy and Procedure. Review Policy and Procedure
33. Meetings with Patient Care Staff, . Meetings with Patient Care Staff, EnvironmentalEnvironmental
Staff and EducationStaff and Education
ImplementImplement
11. . Revise Isolation Policies and C-Difficile Revise Isolation Policies and C-Difficile PolicyPolicy
• All patients with diarrhea on isolation until clearedAll patients with diarrhea on isolation until cleared• Strict Contact IsolationStrict Contact Isolation• Double bag linen and trashDouble bag linen and trash
22. Mandatory education classes for all patient . Mandatory education classes for all patient care staffcare staff
33. Revise Terminal Cleaning Policy. Revise Terminal Cleaning Policy• Expanded terminal cleaningExpanded terminal cleaning• Wall to floorWall to floor• Privacy curtainsPrivacy curtains
44. Environmental Service education. Environmental Service education
ImplementImplement
5. Add 2 Environmental FTEs for 5. Add 2 Environmental FTEs for full 24/7 full 24/7 coveragecoverage
EvaluateEvaluate
11. Staff reactions and concerns. Staff reactions and concerns• Anger over number of isolation roomsAnger over number of isolation rooms• Concern over increase in isolation PPEConcern over increase in isolation PPE• Concern/anger over extra time Concern/anger over extra time
involvedinvolved• Concern by Environmental staff that Concern by Environmental staff that
Patient Care staff Patient Care staff was not using proper techniquewas not using proper technique
2.2. Revise Isolation Policy againRevise Isolation Policy again
3.3. Listened to concerns of Patient Care staff and Listened to concerns of Patient Care staff and Environmental staff Environmental staff
EvaluateEvaluate
Decrease in C-Difficile numbers!!!!!Decrease in C-Difficile numbers!!!!!
Immediate decrease in Immediate decrease in C-Difficile numbersC-Difficile numbers
2007 – 14 cases/21796 X 10000 = Rate 6.02007 – 14 cases/21796 X 10000 = Rate 6.0
2008 - 22 cases/21631 X 10000 = Rate 10.02008 - 22 cases/21631 X 10000 = Rate 10.0
18 cases in 118 cases in 1stst 6 months 6 months
4 cases in 24 cases in 2ndnd 6 months 6 months
2009 - 11 cases/20674 X 10000 = Rate 5.02009 - 11 cases/20674 X 10000 = Rate 5.0
2010 - 8 cases/20255 X 10000 = Rate 4.02010 - 8 cases/20255 X 10000 = Rate 4.0
2011 - 4 cases/14523 X 10000 = Rate 2.7 through 2011 - 4 cases/14523 X 10000 = Rate 2.7 through Sept.Sept.
2011 Changes2011 Changes
New Policy and Procedure New Policy and Procedure
Including definition of diarrhea Including definition of diarrhea 3 loose stools in 24 hours3 loose stools in 24 hours
Reemphasize when testing can be doneReemphasize when testing can be done only 1 per dayonly 1 per day
Decrease in Isolation timeDecrease in Isolation time stop isolation 24 hours after diarrhea stopsstop isolation 24 hours after diarrhea stops
Developed algorithm for C-Dif isolationDeveloped algorithm for C-Dif isolation
Patient has loose stool
Initiate Contact Plus Isolation
No diarrhea or < 3 bouts in 24hs
3 or > loose stoolIn 24 hours
• Discontinue isolation
• d/c stool testing with MD order
Obtain MD order for C-Diff test
All culturesnegative
C-Diff positive
Continue isolation
Loose stools cease X 24 hrs
Terminally Clean room
D/C Isolation
Note: If MD has orderedC-diff test and pt.
has formed stool assess needfor test with MD. Pt does
not need isolation.
NEW ISOLATION NEW ISOLATION CATEGORYCATEGORY
Contact Plus – used for C-Difficile and Contact Plus – used for C-Difficile and other organisms that are not other organisms that are not effected by alcohol hand gel/foameffected by alcohol hand gel/foam
Gloves and gowns when entering room to touch anything Gloves and gowns when entering room to touch anything in environmentin environment
Hand washing with soap and waterHand washing with soap and water
Toxigenic C- Difficile Toxigenic C- Difficile TestingTesting
NAAT – nucleic acid amplification methodNAAT – nucleic acid amplification method
This assay utilizes DNA amplification to This assay utilizes DNA amplification to detect the pathogenicity locus (Paloc)detect the pathogenicity locus (Paloc)
Sensitivity and Specificity rates>95%Sensitivity and Specificity rates>95% Neg predictive value of 99%Neg predictive value of 99% Pos predictive value of 92%Pos predictive value of 92%
Testing CriteriaTesting CriteriaSignificant Diarrhea – 3 or more per 24 hours Significant Diarrhea – 3 or more per 24 hours
Submit Only 1 unformed stool Submit Only 1 unformed stool watery, loose, or taking the form of containerwatery, loose, or taking the form of container
Only 1 specimen will be accepted per diarrheal episodeOnly 1 specimen will be accepted per diarrheal episode Due to high sensitivity of negative test-no need to repeatDue to high sensitivity of negative test-no need to repeat ““Test for cure” for positive test not appropriate because Test for cure” for positive test not appropriate because
patient may carry toxigenic C-Difficile for months after patient may carry toxigenic C-Difficile for months after clinical cureclinical cure
Rare form stools may be accepted with approval of Lab Rare form stools may be accepted with approval of Lab Medical Director when requested by physician.Medical Director when requested by physician.
Thank YouThank You
