Environmental ServicesMicrosystems Team

Cooley Dickinson Hospital

Daniel EnglishLinda Riley

October, 2011

Objective

• On completion of this session, participants will be able to:– State 3 strategies to engage Environmental

Services staff in infection prevention– List 3 interventions that will improve

environmental cleanliness– Demonstrate the effectiveness of UV light in

reducing CDI

Hospital Associated C-Diff Rates

1.16

0.88

0.560.67

1.21

0.75

1.110.88

1.33

0.800.93

0.71

0.0

0.5

1.0

1.5

Q1 2008 Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010 Q2 2010 Q3 2010 Q4 2010Ra

te pe

r 100

0 Pati

ent D

ays

C-Diff Rate Trendline

One Patient’s Story

• 72 yrs of age, diagnosis pneumonia, prescribed antibiotics

• CDI, decreased urine output, kidney failure with hemodialysis for remainder of her life

• OR for colectomy - colon removed, wears a bag• Slow recovery, CCU, on ventilator• Stroke, speech and mobility issues• Readmitted three times• Family members assist with care

Anne

Causative Factors

• How healthcare facilities contribute to CDI:– Insufficient hand hygiene– Insufficient environmental cleanliness– Poor antibiotic stewardship

• Patient risk factors:– Advanced age and underlying illness– Certain medications– Immunosuppression

Two studies highlight contamination of hospital environment with C. diff. spores as a major risk factor.

Dubberke and colleagues, 2003Shaughnessy and colleagues, 2006

• “Both studies raise the issue of contamination of the hospital environment with C. diff. spores as a - if not THE – major risk factor for nosocomial CDI. This issue deserves much greater attention than it has received in the past.

Richard Ellison, MD

Learned About Our Microsystems by Assessing Our 5 P Data –

Patients, Professional, Purpose, Patterns, Processes

• Expectations for work performance not clear to staff

• Difficult to hold staff accountable

• Staff received little training

• Staff feels no power to improve work

• Communication processes cumbersome

Workflow - Fishbone

Work areas are notdefined and have

no task lists or frequencies

MATERIALS PROCESS

PEOPLE ENVIRONMENT

Do not have correct equipment

In disrepair

Tight budget

Unclear expectations

New approaches are needed

Poor training, needs update

Communicationcustomers unawaare

Outdated job flows

Lack of a sense of accountability

Different levels of urgency

Staff set in their ways

Lack of trust in supervisors

Staff overwhelmed

Communication

Short staff at times

Focus on area

Different skill levels

Perception of unfair workload

Carpet hard to clean

BuildingNo laundry chutesSmall soiled rooms

Large floor area

Changes in location of deptswith no notice

Staff Engagement

• Daily Huddles• Patient stories• Making improvements, raising the level of

professionalism• Invite Infection Prevention to your meetings• Data: Infections by unit, Patient survey results• Bulletin board turned into ‘Staff Feedback’• Include EVS staff in hospital and community

news letters• By getting them involved…ask for their opinion

30+ Initiatives Accomplished• Fresh eyes• Communication• Dept aim statement• Job flows• Inspections• Chemical Inventory reduced• Confidential trash• Sharps containers• Instigated daily huddles• ED Turnaround• Seven step cleaning

process• Code of conduct • Patient interaction scripts• Reduce clutter• Equipment storage• Blood borne pathogens• Patient room work flow

• Standards and Regulations, OSHA, TJC, DPH,

• Precaution room process• C’diff room communication with

Infection Prevention• TB and Negative Pressure Rooms• Soiled Linen bags• ED Cleaning, working together• Uniform switch over• 2 % below budget initiative• ESCt program • Micro-fiber cleaning products• Relocate the department• Meeting room furniture• Pass codes, keys and pagers• Stairwell cleaning schedule• Steam cleaning

Improvements targeting C-diff

• Trained in the 9 step cleaning process • ESCt room management system• Increased ES staff by 2 FTEs• Average turn around time from 65 to 48 Mins• Education on chemical efficacy and dwell time• Cleaning time from 14 mins to 24 mins• Microfiber cloths/mops• Restroom cleanliness, Bleach in all

Bathrooms / ED / Cdiff rooms• PX-UV Light treatment

Focus on the Environment

PX-UV Light

Xenex PX-UV Light : Taking Disinfection to the Next Level

• Destroys all major classes of microorganisms that cause hospital-acquired infections.

• Uses high intensity broad spectrum UV light to penetrate the cell walls, fusing their DNA, leading to instant damage and the inability to reproduce or mutate.

• 99.99% of germs and spores are killed.• Goal: Flash all discharged patient rooms;

Flash OR’s & ED daily.

Implementation

• Attention

• Intention

• What does it mean for my work?

• Accountability

• System support

Challenges

• 1st Step

• Contract

• Early adopter of new technology

• Flow

• Procedure and Equipment

• Sustaining Change

Outcomes

Rate of CDH Acquired C. diff., MRSA and VRE Q1-Q3, 2006 through 2011 YTD

0

0.5

1

1.5

2

2.5

2006 2007 2008 2009 2010 2011

Year

Rat

e pe

r 10

00 p

atie

nt d

ays 64% decrease in

CDH acquired Infections

Number of Patients with Poor Outcomes after Acquiring C. diff. at CDH2009- June 2011

8

6

0

1

3

00

1

2

3

4

5

6

7

8

9

2009 2010 2011

Year

# P

atie

nts

Deaths

Colectomies

100% Decrease in Poor Outcomes

2011 YTD

Thank you.

Questions?