Friday, December 23, 2016 Written by Melissa G. Morgan, BSN, RN, CIC, Infection Prevention Data Analyst, Cone Health

The Perfect Storm

Multi-campus Health System Fulfills Senior Management Challenge to Dramatically Reduce HAIs

From December 2007 through December 2010 Cone Health (known as Moses Cone Health System at the time) participated in the VHA initiative to prevent healthcare-associated MRSA infections.

As part of this initiative, they implemented a number of interventions such as requiring all ICU patients to bathe in chlorhexidine gluconate, hand hygiene programs for healthcare providers, and environmental cleaning programs. Despite all these efforts, the MRSA transmission rate remained stagnant — ranging from 0.05 to 0.72 per 1,000 patient days. Cone Health consistently ranked in the lowest 10% of hospitals participating in the VHA initiative.

This situation was particularly frustrating for members of the infection prevention team who knew there were other things that could be done to impact infection rates. In December 2010, they got what they needed.

The safety and well-being of our patients and communities comes first. With that as our focus, we need to take a 'no-holds-barred' approach to ensure we are applying best practices and doing everything within our control to eliminate infection risk across Cone Health.”

- Terrance Akin Chief Operations Officer at Cone Health

In December 2010, during a presentation to the Quality Leadership Team (QLT) about the status of the VHA initiative, new COO Terrance Akin challenged the Infection Prevention team to "make it happen". What followed was a remarkable transformation of the infection prevention program at Cone Health.

Coincidently, six months prior to the meeting with the QLT, the Infection Prevention team had been piloting a MRSA surveillance trial using Cepheid's rapid PCR testing technology for patients in three ICUs. The results of the pilot were impressive. In six short months they were able to achieve surveillance compliance rates over 95%. Knowing which patients were colonized with MRSA allowed the Infection Prevention team to closely monitor those patients to make sure that decolonization protocols were being implemented in a timely manner.

As a result of the pilot program data and meetings of the MRSA Taskforce, several key components for a new approach to HAI prevention at Cone Health were identified:

1 Infection Prevention was provided with two additional FTEs and two other ICP were promoted to leadership roles (Infection Prevention Manager and Infection Prevention Data Analyst). A new electronic data mining system was implemented to provide the ICPs real-time data on a patient's colonization status and the status of infection prevention measures implemented.

2 Surveillance testing was expanded from the original three units to patients in all ICUs, including step-down units as well as to all high-risk and pre-surgical patients. All this was implemented a period of over six months. To accommodate the dramatically increased testing volume (approximately 2,000 tests/month) the laboratory acquired a GeneXpert® Infinity System.

3 Environmental Services' efforts were supplemented by the acquisition of a Xenex™ Disinfection System for the decontamination of rooms previously occupied by patients infected with MRSA. This system helped remove human error from the process of properly cleaning and disinfecting patient rooms to help ensure better compliance with environmental cleaning policies.

4 Education of clinical personnel as well as patients and their visitors was expanded through a program titled, "Step up. Scrub up."The basis of this program was the World Health Organization's five steps to hand hygiene improvement. The program assisted in gaining better hand hygiene compliance among more than the 8,000 employees of Cone Health.

The early results were impressive. In the first six months of the program, Cone Health has not seen a single MRSA infection. The program has also proven to be successful from an economic perspective.

Our active surveillance program has reduced the cost of infections for the health system in these three units alone by more than $2 million. When we compare the patients who acquired an infection before the pilot to during the pilot we see the cost decrease from $3.7 million to $1.3 million. Subsequently, reducing hospital days for these patients by more than 1,300 — allowed those beds to be used for additional patients.”

- Melissa Morgan, Infection Prevention Data Analyst at Cone Health