Round and Round We Go: The Development of an Effective, Sustainable Multidisciplinary Rounding...
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Environment of Care/Construction/ Remediation Presentation Number 6-320 A Quality Control Study of Practice of Urinary Catheterization and Knowledge among Junior Medical Staff Muhammad R. Cheema BSc, MBBS, MRes, F2, Wirral University Teaching Hospital, Wirral, Merseyside, UK BACKGROUND/OBJECTIVES: Our study was conducted in the inpatient setting of Department of Elderly Medicine. A high percentage of indwelling catheters at discharge had been observed. Despite symptomatic benefit from placing a urinary catheter, they are often implicated in causing recurrent urinary tract infections, discomfort, and retention resulting from catheter blockage and are associated with an increased frequency of readmission. Our study aimed to ascertain whether these catheters were being placed for appropriate indications. METHODS: In the first cycle data was collected over a period of two 2 weeks from notes of 61 elderly patients with urinary catheters. Medical notes were used to identify the indications for catheteri- zation and to assess proper documentation pertaining to procedure of catheterization. This documentation comprised date, time, indication of catheterization, personnel name, catheter size, volume and colour of urine drained, use of aseptic technique and antibiotic prophylaxis given. To evaluate the knowledge among the staff regarding indications, complications and documentation of catheterization, questionnaire survey was carried out.After the initial cycle the ward managers and junior staff (junior doctors and nurses) were made aware about the findings of the audit through the presentation of the results in local grand round meeting. Lectures were given to the junior staff regarding the indications for catheterisation. Ward managers and nurses in charge of elderly patients ward were informed about disseminating the knowledge regarding the indications and complications of catheterisation to the nursing staff. A repeat cycle of the audit was conducted 6 months after the intervention was carried out to assess the impact of the intervention. RESULTS: Our study revealed that 90% of total catheterizations in the first cycle were performed with complete/adequate documen- tation and for appropriate indications as per the IDSA guidelines. However, in the second cycle after the intervention, 95.5% of total catheterisations were performed for the appropriate indications. In the first cycle,documentation of the date of procedure, the indica- tion for catheterization use of aseptic technique: 100% agreed.Do- cument if prophylactic antibiotics were given and if a sample was sent for analysis: 77% of agreed. Document the volume of urine drained: 97.4% agreed. 89.7% of them agreed they would document a description of the urine drained and 87% of them acknowledged they would document if it was a difficult procedure or not.After a period of 6 months post intervention, the results of the second cycle were encouraging. It showed positive attitudes and practices after the intervention. There were fewer number of inappropriate urinary catheterisations. Largely, the urinary catheterisation was performed for the appropriate indications (95.5%) in accordance with the IDSA guidelines for catheterisation. Less number of unclear indications were seen (4.5%) in the second cycle as compared to the 1st cycle (10%). CONCLUSIONS: Responses to the questionnaire demonstrated good awareness of what needed to be documented among staff. How- ever, the practice of documentation did not reflect the awareness demonstrated in the questionnaire in the first cycle. The awareness also improved in the second cycle after intervention. The work also highlighted that there is a significant gap between the knowledge regarding urinary catheterisation and the practice performed by the junior staff. However, reinforcement with lectures has shown an improvement in this practice. This highlights the knowledge deficit which can be addressed with more effective educational interventions at both the undergraduate level (eg curriculum changes) and at the postgraduate level (eg training and assessment as part of hospital induction). Presentation Number 6-321 Round and Round We Go: The Development of an Effective, Sustainable Multidisciplinary Rounding Process Kim Strelczyk RN, MSN, ACNS-BC, CIC, Consultant, Specialists in Infection Prevention & Control, LLC; Christie Vandygriff RN, BSN, Infection Preventionist, Covenant Health ISSUE: Regulatory and accrediting agencies have recently increased scrutiny of the environment in hospital surveys. Many findings are cited in “Infection Control” chapters. In early 2012, our acute care hospitals were surveyed by the Centers for Medicare/Medicaid Services (CMS) and cited for a number of environmental issues. There is very little information published or available in Infection Prevention (IP) courses regarding “how to” effectively conduct environment of care (EOC) rounds. Historically, EOC rounds were conducted only twice a year at our hospitals, we had no stan- dardized tool, and no scoring mechanism. In addition, we found that Department Managers (DM) did not realize their responsibility toward assuring a clean and safe environment. PROJECT: We developed 5 teams of experts from IP, Environmental Services (EVS), Plant Operations (PO), and Safety. IPs served as Team Leaders for teams. Schedules were developed to ensure that all clinical areas were rounded upon monthly and all others quar- terly. Eleven outpatient areas/clinics were included. A standard operating procedure was developed. A rounding tool was created Poster Abstracts/ American Journal of Infection Control 41 (2013) S25-S145 S67 APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
Transcript of Round and Round We Go: The Development of an Effective, Sustainable Multidisciplinary Rounding...
Poster Abstracts/ American Journal of Infection Control 41 (2013) S25-S145 S67
Environment of Care/Construction/Remediation
Presentation Number 6-320A Quality Control Study of Practice of UrinaryCatheterization and Knowledge among JuniorMedical Staff
Muhammad R. Cheema BSc, MBBS, MRes, F2, Wirral UniversityTeaching Hospital, Wirral, Merseyside, UK
BACKGROUND/OBJECTIVES: Our study was conducted in theinpatient setting of Department of Elderly Medicine. A highpercentage of indwelling catheters at discharge had been observed.Despite symptomatic benefit from placing a urinary catheter, theyare often implicated in causing recurrent urinary tract infections,discomfort, and retention resulting from catheter blockage and areassociated with an increased frequency of readmission. Our studyaimed to ascertain whether these catheters were being placed forappropriate indications.METHODS: In the first cycle data was collected over a period of two2 weeks from notes of 61 elderly patients with urinary catheters.Medical notes were used to identify the indications for catheteri-zation and to assess proper documentation pertaining to procedureof catheterization. This documentation comprised date, time,indication of catheterization, personnel name, catheter size,volume and colour of urine drained, use of aseptic technique andantibiotic prophylaxis given. To evaluate the knowledge among thestaff regarding indications, complications and documentation ofcatheterization, questionnaire survey was carried out.After theinitial cycle the ward managers and junior staff (junior doctors andnurses) were made aware about the findings of the audit throughthe presentation of the results in local grand round meeting.Lectures were given to the junior staff regarding the indications forcatheterisation. Ward managers and nurses in charge of elderlypatients ward were informed about disseminating the knowledgeregarding the indications and complications of catheterisation tothe nursing staff. A repeat cycle of the audit was conducted 6months after the intervention was carried out to assess the impactof the intervention.RESULTS: Our study revealed that 90% of total catheterizations inthe first cycle were performed with complete/adequate documen-tation and for appropriate indications as per the IDSA guidelines.However, in the second cycle after the intervention, 95.5% of totalcatheterisations were performed for the appropriate indications. Inthe first cycle,documentation of the date of procedure, the indica-tion for catheterization use of aseptic technique: 100% agreed.Do-cument if prophylactic antibiotics were given and if a sample wassent for analysis: 77% of agreed. Document the volume of urinedrained: 97.4% agreed. 89.7% of them agreed they would documenta description of the urine drained and 87% of them acknowledgedthey would document if it was a difficult procedure or not.Aftera period of 6 months post intervention, the results of the secondcycle were encouraging. It showed positive attitudes and practicesafter the intervention. There were fewer number of inappropriateurinary catheterisations. Largely, the urinary catheterisation wasperformed for the appropriate indications (95.5%) in accordancewith the IDSA guidelines for catheterisation. Less number ofunclear indications were seen (4.5%) in the second cycle ascompared to the 1st cycle (10%).
APIC 40th Annual Conference j Ft La
CONCLUSIONS: Responses to the questionnaire demonstrated goodawareness of what needed to be documented among staff. How-ever, the practice of documentation did not reflect the awarenessdemonstrated in the questionnaire in the first cycle. The awarenessalso improved in the second cycle after intervention. The work alsohighlighted that there is a significant gap between the knowledgeregarding urinary catheterisation and the practice performed bythe junior staff. However, reinforcement with lectures has shownan improvement in this practice. This highlights the knowledgedeficit which can be addressed with more effective educationalinterventions at both the undergraduate level (eg curriculumchanges) and at the postgraduate level (eg training and assessmentas part of hospital induction).
Presentation Number 6-321Round and Round We Go: The Development of anEffective, Sustainable Multidisciplinary RoundingProcess
Kim Strelczyk RN, MSN, ACNS-BC, CIC, Consultant, Specialists inInfection Prevention & Control, LLC; Christie Vandygriff RN, BSN,Infection Preventionist, Covenant Health
ISSUE: Regulatory and accrediting agencies have recently increasedscrutiny of the environment in hospital surveys. Many findings arecited in “Infection Control” chapters. In early 2012, our acute carehospitals were surveyed by the Centers for Medicare/MedicaidServices (CMS) and cited for a number of environmental issues.There is very little information published or available in InfectionPrevention (IP) courses regarding “how to” effectively conductenvironment of care (EOC) rounds. Historically, EOC rounds wereconducted only twice a year at our hospitals, we had no stan-dardized tool, and no scoring mechanism. In addition, we foundthat Department Managers (DM) did not realize their responsibilitytoward assuring a clean and safe environment.
PROJECT: We developed 5 teams of experts from IP, EnvironmentalServices (EVS), Plant Operations (PO), and Safety. IPs served asTeam Leaders for teams. Schedules were developed to ensure thatall clinical areas were rounded upon monthly and all others quar-terly. Eleven outpatient areas/clinics were included. A standardoperating procedure was developed. A rounding tool was created
uderdale, FL j June 8-10, 2013
Poster Abstracts/ American Journal of Infection Control 41 (2013) S25-S145S68
that provides DM with an overall score, as well as an Action Plan(AP) section. DM were asked to utilize the AP section to respond todeficiencies within one week. This electronic tool automaticallycalculated and fed scores to an aggregate report, providing trendingby category and by line item (figure 1). In order to enhance inter-rater reliability and data consistency, rounding team membersreceived training on each item included in the tool. DM receivedtraining on the entire rounding process, including their role. Workorders were placed at the time of rounds for PO issues.RESULTS: DM are now more knowledgeable about their role inassuring a clean and safe environment. Initial review of sectionscores revealed PO and EVS being the lowest. This informationenabled us to focus on the most critical areas and helped justify theaddition of much needed staff to the EVS department.LESSON LEARNED: We implemented an effective and sustainableprocess for environmental rounding that satisfied CMS upon re-visit. We are now able to quickly identify and mitigate environ-mental and IP issues in our facilities. The consistent presence of IPstaff throughout the organization and the availability of an elec-tronic, interactive tool have increased awareness of environmentalsafety and related IP practices from front line staff to administra-tion, medical staff and the Board.
Presentation Number 6-322Evaluation of the Potential for Hospital AcquiredInfection from Live Plants in a Health Facility Atrium
Lewis Johnson CIH, Industrial Hygienist, Epidemiology/InfectionPrevention, Lee Memorial Health System
ISSUE: Live plants are popular in buildings for their beauty andthe natural feel they bring to the indoor environment. Benefits tobuilding occupants may include reduced stress and increased taskperformance. For a typical commercial building, the presence ofplants has a positive effect on perceived employee health andreduced employee absenteeism. In a health care facility, the pres-ence of living plants brings a concern of potential increased risk ofHAI from microbial pathogens associated with the live plants. Ourgoal was to reach an evidence-based decision balancing any in-creased risk of infectionwith the perceived benefits provided by liveplants in the building atrium. To asses the risks of patient infection,samples were collected to determine if potentially infectiousorganisms were present on the plants and in the soil, and if so, thedegree to which any of these organisms became airborne.PROJECT: Soil samples from planters were collected and culturedto identify bacterial and fungal organisms. Potentially pathogenicmold species were identified in the soil, but no infectious thermo-philic bacteria were found in these samples. Tape samples collectedfrom plant leaves yielded mold spores with similar concentrationand diversity as other nearby building surfaces. These samples didnot identify significant mold growth on the plants themselves.Sporetrap air samples were collected during maintenance work onthe planters to determine the extent to which molds growing in theplanters became aerosolized during routine maintenance activitiessuch as irrigation, replanting, dead leaf pulling and plant pruning.RESULTS: Sporetrap sampling indicated that disturbance of the soilin which the plants are grown is the primary source of the airbornemold spores. Drip irrigation was least soil disturbing maintenanceactivity, and resulted in the lowest concentration of airborne moldspores. Pruning generated large quantities of airborne dust fromthe handling of large leaves, but the resulting airborne mold sporesweremoderate compared to other activities. Walking on soil to pick
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leaves, digging plants out, and water spray hitting soil whenwatering created the highest levels of airborne mold spores.LESSON LEARNED: The presence of live plants does not appear torepresent a significant increase in exposure to airbornemold sporesif maintenance can be performed without disturbing the soil.Options for reducing soil disruption include growing plants wherethey are accessible without contacting soil, using subsurface or dripirrigation, and containing plants to allow replacement withoutdisturbing soil.
Presentation Number 6-323Evaluation of Adenosine triphosphate Measurementto Monitor Hand Hygiene in ICU
Yuxin Ma, Doctor, Fuwai Heart Hospital & Cardiovascular Institute
BACKGROUND/OBJECTIVES: Standard evaluation for surgical handwashing is based on the glove juice method using bacterial culture.However, this method is complicated and routine implementationis difficult. The measurement of adenosine triphosphate (ATP)using bioluminescent method (ATP method) is a reliable and rapidmethod to evaluate cleaness. However, there is still controversyabout whether ATPmethod could be used to evaluate hand hygienein hospitals. The purpose of this study is to compare ATP methodand agar method for evaluation of hand hygiene in ICU.METHODS: Samples were obtained according to themodified glovejuice method during working hours. ATP of the samples weredetermined by AccuPoint HC system (Neogen, USA).RESULTS: Setting 100 relative light units (RLU) and 5 Colonyforming unit per one hand as the pass threhold, the coincidence ofATP method with agar method was 90%. RLU readings on arriving(320), after morning shift meeting (247) and during operation (143)were higher (P¼0.01). Lowest pass rates were found in doctors(73%) and cleaners (75%) among medical workers in ICU. However,the CFU reduction rate did not correlate with the ATP reductionrate, probably because ATPs exist in bacteria as well as in non-bacterial sweat and skin drop debris and both are measured.Average RLU readings decreased to 45 from 148 after 3 monthobservation, while weekly consumption of hand cleaner and handsanitizes showed a increase of 12% and 10%, respectively.CONCLUSIONS: It is conclued that the ATP method provides resultsrapidly with improved benefits in the control of hand hygiene andthus could be used as a intervention action to improve handhygiene of medical workers.
Presentation Number 6-326A Comparative Study of Touch-free Hand HygieneDispenser Battery Life: Impact on Sustainability andMaintenance Frequency
Cheryl Littau PhD, Senior Scientist, Ecolab; Nicole Burns B.S.,Principal Chemist, Ecolab; John Pelkey, Senior Engineer, Ecolab;Viktor Slobodyan, Scientist, Ecolab; Cheryl Littau, SeniorScientist, Ecolab
BACKGROUND/OBJECTIVES: Touch-free hand hygiene dispensersare growing in prevalence in acute care settings. Ease of use anda perceived lower potential for cross contamination are two keyreasons for this. Touch-free dispensers are powered by batteries,which must be replaced periodically. Obviously, it is desirable tomaximize battery life, to reduce the need for maintenance (and
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