CDI Collaborative: Our Journey 11/11 to Present

1. CDI Collaborative: Our Journey 11/11 to Present Merrimack Health Group Marlborough Hills Health Care Center

2. Objectives • Identify at least 3 practical ways to improve overall facility infection control • State at least 3 interdisciplinary measures to reduce the incidence of CDI • Identify at least 3 practical ways to implement environmental changes in your facility

3. How we Began our Journey… November 2011 • MA Senior Care Newsletter • CDI Hospital SNF Collaborative • Contacted MA Coalition for Prevention of Medical Errors • Our Marlboro facility assigned to partner with MWMC • First SNF-Hospital CDI Collaborative meeting • Additional Collaborative meetings and conference calls

4. MWMC-SNF CDI Team:Individual Team Assessment Prepared by MWMC Infection Control Practitioner • Mechanism to start our in house assessment • Identified facility team members and role in facility • Reassessed the number of cases of CDI last year • Reviewed corporate nursing & infection control policies and procedures • Examined environmental supplies and practices • Assessed whether visitors follow proper infection control guidelines

5. The Team • Unit Managers • Director of Social Service • Director of Dietary • Activities Director • Director of Maintenance • Director of Environmental Services • Front line staff: CNA’s from LTC and subacute units • Administrator • DON • Senior Director of Clinical Services for Merrimack Health Group • Regional Clinical Consultant for Merrimack Health Group • SDC • Case Manager • NP • Director of Rehab

6. In House Meetings • Initially whole team met every 2 weeks • Interdisciplinary subcommittees established • Infection Control Committee • Education Committee • Environmental Committee • Healthy Hands & Aesthetics Committee • Antibiotic Stewardship Committee Much progress made and was tested in February when we had a GI outbreak… stay tuned

7. Infection Control and Education Committees • New evidenced based corporate policies and procedures with clinical competencies • Cdi • Contact Plus Precautions • Hand Hygiene-Glitter Bug a huge hit! • Alcohol based hand rubs • Soap and water • MHG Hand washing & CDI Needs Assessment • Expanded upon MWMC questionnaire • Distributed to all Directors of Nursing/SDC’s • Results/assessment to Regional Clinical Consultant • DON/SDC inserviced before p&p rolled out in facilities

8. Infection Control and Education Committees: • MHG Hand washing & CDI Needs Assessment • Expanded upon MWMC questionnaire • Distributed to all Directors of Nursing/SDC’s • Guide to assess if facility compliant with newest p&p • Review education, audits, equipment, supplies • Review environmental services • Assess antibiotic usage in the facility • Results/assessment to Regional Clinical Consultant • DON/SDC then educated prior to implementation of new hand washing and cdi programs

9. Infection Control and Education Committees • Started reviewing all infections daily @ skilled meeting • Completed inventory of infection control equipment in facility • Contact Precaution & Contact Plus signs revised • “Report to Nurse” stop signs revised • Ordered disposable equipment for CDI patient rooms • Blood pressure cuffs • Stethoscopes • Thermometers • Glucometers • Gait belts different color • Instituted neon green colored interdepartmental infection communication forms • Learned effectiveness of cohorting patients with cdi

10. Infection Control and Education Committees • Based interventions & programs on the “PracticeOpportunities for CDI Prevention” hand out • “Jasper Palmer Method” as seen on Youtube • Developed CDI FAQ brochures • Staff version also available in Spanish & Portuguese • Patient and visitor version • Developed Infection Control FAQ brochure • Put into patient welcome bags • Community outreach: • Q & A Cable program for Marlboro Seniors

11. Infection Control and Education Committees • Education for environmental services • Translators were available at time of inservice • Communication Cards created • Facilitate clear communication between departments • Spanish and Portuguese with English equivalent • Mandatory Inservice Fair for all staff • New P & P’s • Competencies were completed

12. Environmental Committee • SDC audited housekeeping & laundry • Assessed practice opportunities for cdi prevention • Equipment • Environment • Cleaning solution options • Implemented “CDC environment checklist for monitoringterminal cleaning:” • Helped to identify high touch room surfaces • Microfiber mops purchased • Still exploring UV disinfection system • Bleach wipes readily available

13. Healthy Hands and Aesthetics Committee • Hand wipes for patients to use before meals • Hand washing at patient activities • Hand washing audits • Fun & unique hand washing framed signs • Used ideas from collaborative • Commode liners very effective • Containing the cdi • Reduced odor • Staff ease of use

14. Antibiotic Stewardship Committee • Pharmacy antibiotic records reviewed • Collated meds by prescriber; then used to identify: • Prescribing patterns • Opportunities for re-education • Number of patients with cdi • Initial • Recurrent • Results given to DON’s/SDC’s for their review

15. What happened in February… • Many patients admitted with gastroenteritis • Subsequent new cases of concomittant cdi • CDC –gastroenteritis predisposes patients to cdi! • Put all departments new skills to the test • Yellow gowns became a fashion statement  • Found that cohorting was an important part of eradicating cdi

16. After the “invasion…” • Only 2 cases of facility acquired cdi (antibiotic use) • We continue to meet as a team monthly • Track cdi as a part of our CQI We are so appreciative for all that we have learned from being a part of the CDI collaborative!

17. Questions? Comments? Our Journey continues…&We wish you luck with yours!