1. Turning the corners across the border in eliminating C-difficle
The Toronto Western Hospital
General Internal Medicine Story

2. Objectives To share the general internal medicine and UHN C-diff story
To discuss the multiple strategies for staff engagement
To share our staffs innovations and changes
Share the data

3. Who we are & How it all began
One of Canada’s largest academic hospitals
General Internal Medicine Program
2006- multiple outbreaks
with high mortality rates,
increased length of stay
and recurrent unit closures
Poor staff satisfaction,
poor care reputation
GIM- 110 % occupancy, with patients cared for in hallways,

4. Something had to be done…
Traditional education
One on one meetings with the manager
Mandated e-learning modules
Incident reports of breeches
Staff meetings
Daily reminders
Disciplinary action
Initial Strategies did not work

5. There was NO change in outcomes… Time to take a different approach

6. Ask those involved and they have the answer
It’s a team approach
Its about open listening, and trying the unexpected
Team approach- residents and medical teams are transient up to 50 medical interns and trainees and multiple consult services, so we concentrated on nursing, portering, housekeeping, food services, allied health as our team.

7. Its about taking chances
Loose stool Log
No sinks- install sanitizer everywhere
Lessons- Loose stool log- communication tool
No sinks sanitizer is everywhere. But don’t put on the patients tables, as they will drink it

8. And the answers will come
House keeping standards
Remodeled clean and dirty utility room

9. Patient specific equipment Patient Education
Patient education (signage and pamphlets

10. Our IPAC Commitment

11. Maintaining our commitments
Today…
Commitment to transparency
Debriefing on nosocomial infections
Rewards (Individual pens, 30 day noso-free lunches)
Commitment to have open discussions
Commitment to hold all staff to the same standard

12. Success Nosocomial (acquired on the floor) CDAD rate, 8A compared to TWH overall and UHN

13. CDAD

14. Nosocomial (acquired on the floor) MRSA rate, 8A compared to TWH overall and UHN

15. MRSA

16. Nosocomial (acquired on the floor) VRE rate, 8A
compared to TWH overall and UHN

17. VRE

18. Questions

19. Objectives To share the general internal medicine and UHN C-diff story
To discuss the multiple strategies for staff engagement
To share our staffs innovations and changes
Share the data