University of Texas Health Center Infection Control Collaborative Overview
University of Texas Health Center Infection Control Collaborative, led by Jan Evans Patterson, MD, focuses on improving patient safety through collaborative efforts. The program includes clinical and quality improvement experts working together on topics like multi-drug resistant organisms, hand hygiene, and infection prevention. With a multidisciplinary approach and the involvement of various healthcare professionals and institutions, the collaborative aims to enhance the quality of care and safety measures. The team comprises professionals from University of Texas Health Science Center at San Antonio, University Health System, South Texas Veterans Health Care System, and University of Texas Health Science Center at Houston.
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The University of Texas Health Center Infection Control Collaborative Jan Evans Patterson MD MS Associate Dean for Quality & Lifelong Learning Work supported by UT System, UTHSCSA, VA Educating for Quality Improvement & Patient Safety
What is a Collaborative? Features 1) A specified topic with variations in care or gaps between current and best practice, 2) Clinical and QI experts provide ideas and support, sharing knowledge and best practice, 3) A critical mass of multiprofessional teams from multiple sites willing to improve and share, 4) Setting clear and measurable targets, collecting data, and testing changes on a small scale to learn by doing, and 5) Collaborative process involving structured activities. Interprofessional collaboration is critical to optimize safety and quality.
Specified Topic 1) A specified topic with variations in care or gaps between current and best practice Control and prevention of multi-drug resistant organisms
Clinical & QI Experts Sharing 2) Clinical and QI experts provide ideas and support, sharing knowledge and best practice. Topics Hand hygiene compliance 2009 H1N1 best practices MRSA prevention Isolation compliance & environmental cleaning
Clinical & QI Experts Sharing 3) A critical mass of multiprofessional teams from multiple sites willing to improve and share.
Co-Investigators and Collaborators University of Texas Health Science Center at San Antonio University Health System (UHS) and South Texas Veterans Health Care System (STVHCS) Jan Patterson, MD (PI), Professor and Healthcare Epidemiologist, UHS; CS&E course director Beth Ann Ayala, MT(ASCP), UHS Infection Preventionist James Lewis, PharmD, UHS Infectious Diseases Pharmacist Jose Cadena Zuluaga, MD, STVHCS Healthcare Epidemiologist Patti Grota, RN, MSN, STVHCS Infection Preventionist Kelly Echevarria, PharmD, STVHCS Infectious Diseases Pharmacist Edna Cruz, RN, (Consultant) STVHCS Quality Improvement and CS&E Instructor Amruta Parekh, MD, MPH, UTHSCSA Educational Development Specialist, CS&E course Letti Bresnahan, MBA, UTHSCSA Project Coordinator, CS&E course UT Health Science Center at Houston Luis Ostrosky-Zeichner, MD (Co-I); Professor of Medicine and Medical Director, Hospital Epidemiology and Infection Control, Memorial Hermann Hospital Virgie Fisher, CIC, Infection Preventionist Edgar Rios, PharmD, Pharmacist Kathy Luther, RN (Consultant), CS&E course
Co-Investigators and Collaborators UT M.D. Anderson Cancer Center Roy F. Chemaly, MD, MPH (Co-I) Associate Professor of Medicine, Director of Infection Control Program, Healthcare Epidemiologist Cheryl Perego, MPH, Infection Preventionist, Supervisor, Infection Control Program Linda Graviss, MT(ASCP), Senior Infection Control Preventionist, Doris Quinn, PhD (Consultant), CS&E course director UT Medical Branch at Galveston Glenn Mayhall, MD (Co-I), Professor of Medicine, Healthcare Epidemiologist Jennifer Baer, RN, MS, CPHQ, Quality Improvement Pam Falk, RN, CIC, Infection Preventionist University of Texas Southwestern Medical School James Luby, MD (Co-I); Professor & Hospital Epidemiologist, Zale Lipshy Hospital, University Hospital Doramarie Arocha, MS, MT(ASCP), Infection Preventionist, University Hospitals William Tharpe, PharmD, Pharmacist Pranavi Sreeramoju, MD, MPH (Co-I); Assistant Professor and Healthcare Epidemiologist, Parkland Health & Hospital System Thomas Button, RN, CIC, Infection Preventionist, Parkland Health & Hospital System
Metrics and Testing Change 4) Setting clear and measurable targets, collecting data, and testing changes on a small scale to learn by doing.
Metrics: Infection Control Practices Hospital Infection Control Practices Anti-biogram Active Surveillance Cultures for MRSA MDRO line list NHSN (Y/N) Y (begun Nov 09 Pedi ICU CRBSI) Ratio ICP:beds 1:100 (also have >1 million outpt visits/yr) 1:200 1 Yes Yes No (pilot in Head & Neck pts) 2 Yes Yes Yes adult ICU PICU NICU Yes In ICUs and 2 wards pending 3 MRSA, VRE Yes Y: CRBSI and VAP for adult ICUs 1:110 operating beds or 1:135 total beds 1:100 acute 1:150 w LTC 1:175 4 Yes Yes Yes all acute care No Planned 5 Yes Yes No 6 7 Yes Yes Yes for defined groups (LTAC) No 1:130 operating beds or 1:150 total 1:100 Yes Yes Yes for ICU Yes
Metrics: Hand Hygiene Compliance Hospital Metrics Hand Hygiene Compliance July-Sept 09 Sept-Dec 09 Jan-Mar 10 April-Jun 10 83% 79% 76% 71% (implementing new initiative) 98% (Apr/May) 1 89% 89-96% 2 84% Transitioning to different methodology 92% 89% April 85% May 87% 3 June 91% 92% 89% 87% 4 93.5% 94.3% 93.1% 94.6% 5 86% 89% 90% May: 90% June: 91% April 49 % May 58% June 64% 6 In Progress February 78% March 60% 7
Influenza Practices & Metrics Hospital Influenza Mask policy Seasonal flu vaccination rate in HCW 1 CDC 70% overall (90% in HCW for high risk pts) 2 CDC 47% 3 SHEA/ WHO 75% 4 CDC 85% 5 SHEA / WHO 76% 6 CDC 34% 7 CDC 85%
Practices: Antibiotic Stewardship Antibiotic Stewardship Hospital Anti-infective Mgt Team Antibiotic use data available? 1 No longer funded Not readily, but yes 2 Yes Yes 3 Not really Not readily, but yes 4 Yes Not readily 5 Yes Not readily In-progress 1st meeting in April 6 Work in progress 7 No Yes
Collaborative Process 5) Collaborative process involving structured activities. Face to face meetings Texas ID Society, IDSA, SHEA Webinars ~ 5 - 6 times/year Email distribution list Contact information
PDSA Cycle (Source: Quality Improvement Tools & Techniques) This template designed to help instruct, construct and present an improvement project Set goals based on customer needs PLAN PLAN Implement DO ACT PLAN DO Analyze what happened STUDY STUDY DO STUDY Make sure improvement is permanent ACT ACT
Joint Commission RFI South Texas Veterans Health Care System All Units FY 08 HAND HYGIENE 100% 80% 64% 69% 67% 60% 40% 20% 0% 1st 2nd 3rd 4th Cumulative Quarter FY08 Quarter FY08 Quarter FY08 Quarter FY08 Target = > 90% !!
Training for Staff Refer your staff for training as needed The Wash room March 18 and 19 1 hour workshop All 3 shifts
Update South Texas Veterans Health Care System Hand Hygiene Compliance Acute Care Trends 1st Q FY09 90% 92% 67% 96% 100% 100% 98% 80% 100% 78% 72% 70% 80% 60% 40% 20% 0% CCU SICU SCIC BMT MICU 4S 5A 6B 5 PCU Cumulative K5MED total # of observations/opportunities 687/704=98% compliance Who?
Timeline April 17 CDC confirmed 1st novel H1N1 virus in California April 23 Cases confirmed in Texas April 24 Confirmation of flu-like illness in Mexico reported Late April - Schertz-Cibolo Universal City schools closed
SCREENING STATION BETWEEN UH AND VA
MRSA Reduction at Parkland Memorial Hospital Pranavi Sreeramoju, MD, MPH Assistant Professor, Medicine Infectious Diseases UT Southwestern Medical Center Chief of Infection Prevention Parkland Health and Hospital System UT IC Collaborative Webinar June 2, 2010
Where we are now 10.00 Rate of CA-BSI in ASC Units 8.00 Median ASC 6.00 UCL ASC 4.00 Rate of CA-BSI in non- ASC Units 2.00 Median non-ASC 0.00 May-09 Mar-09 Apr-09 Jul-09 Mar-10 Apr-10 Feb-09 Feb-10 Oct-08 Oct-09 Nov-08 Dec-08 Nov-09 Dec-09 FY08 Q3 FY08 Q4 Jan-09 Jun-09 Aug-09 Sep-09 Jan-10 FY08 Q2 UCL non-ASC
MH-TMC Measuring Compliance with Isolation Processes December 1, 2009 Virgie Fisher, CIC Luis Ostrosky, MD
Measuring the Process Isolation label on front of chart Isolation type correct in Care4 Pt. ed. Sheet off cart Written order on chart # Correct Sign # In Isolation Date Apr - 08 - Adult Total audits % Compl. 104 88.1% 98 35 83 60 118 83.1% 29.7% 70.3% 50.9% May - 08 - Adult Total audits % Compl. 57 84 60 88.2 38 56 59 87 45 66.2 68 Jun-08 - Adult Total audits % Compl. 63 95.4 61 92.4 30 45.4 58 87.8 45 68.1 66 Jul-08- Adult/Children Total audits % Compl. 85 80 94.1 43 50.5 38 44.7 68 80 76 89.4
Luis Ostrosky, MD Virgie Fisher, CIC Infection control and hospital epidemiology
6 5 4 3 Total 2 1 0
Education, supervision, and cohorting New trend of MDRA cases in rooms previously occupied by MDRA patients Cleaning issues! Re-training Checklists Room closures and culturing- Enriched culture media 2x terminal clean + A Team , validation
8 60 % % 2X trial starts 7 50 Rooms blocked/cultured after cleaning Rooms blocked/cultured after cleaning 6 40 5 Negatives 4 30 Positives 3 % POSITIVE 20 2 10 1 0 0 JUL 13-19 JUL 20-26 Week JUL 27-AUG2 Week
Specified topic - Control of MDROs Clinical and QI experts provide ideas and support, sharing knowledge and best practice, A critical mass of multiprofessional teams from multiple sites willing to improve and share, Setting clear and measurable targets, collecting data, and testing changes on a small scale to learn by doing, Collaborative process involving structured activities.
Monitoring and best practices for: Catheter-related bloodstream infections Surgical site infections Hand hygiene HCW influenza vaccination rate Other
