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Growing a New Culture: Patient Safety. Nancy Brumley Gessling, MSN, CIC Infection Prevention Copper Basin Medical Center. CBMC Demographics. Polk County – extreme Southeast corner of Tennessee 25 Bed Critical Access, with swing beds 3 bed Emergency Department.
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Growing a New Culture:Patient Safety Nancy Brumley Gessling, MSN, CIC Infection Prevention Copper Basin Medical Center
CBMC Demographics • Polk County – extreme Southeast corner of Tennessee • 25 Bed Critical Access, with swing beds • 3 bed Emergency Department
Infection Control History at CBMC • Old multi-tiered precaution system in place • Not evidence based • IC position frequently open or assigned to available staff nurse • Reluctance to change
Growing a Culture of Safety • Trust and confidence • Observation of IC practices • Needs assessment for education and skills • Data collection and analyses • Physician champion • Identification of stakeholders • Risk assessment for CBMC • Education of staff, physicians, administration
Evidence Based Practice • APIC membership • CDC guidelines • Journal articles for all staff categories • MDRO Surveillance • IC data to hospital PI committee and medical staff • Antibiogram every six months
Barriers to Progress • No in-house Microbiology • Short LOS • Poor attitude toward MDRO prevention • Poor compliance with barrier protection • Poor understanding of transmission based precautions • Poor physician support
Active Surveillance Cultures: or“You want to do What!?” • Based on MDRO surveillance and risk assessment • Detection of asymptomatic or subclinical state in a group of patients who are at risk but would not otherwise be identified. • Colonized patients are reservoir for MDRO transmission • Both infected & colonized pts contaminate their environment with the same relative frequency
ASC by the book • Decisions about which populations should be targeted for active surveillance should be made in the context of local determinations of the incidence and prevalence of MDRO colonization within the intervention facility as well as other facilities with whom patients are frequently exchanged CDC MDRO Guideline 2006
Stakeholder Relationships • Who is really affected by the process? • Proactive communication • Evidence based practice is essential • Track, trend, and monitor interventions • Share your success
ASC as part of a MDRO Bundle • Identify patient on admission as targeted for ASC • Obtain nasal swab on admission • Contact Precautions on admission • Barrier protection for every patient encounter • Hand hygiene in and out of room every time • A bundle is “all or nothing”
ASC Implications • Not implemented in hospitals to diagnose or treat infections • Used as a tool to provide a safer environment for reducing risk of MDRO transmission • Should be viewed as a QI measure • Prevent harm for isolated patients by providing equally attentive care to all patients