1. Growing a New Culture: Patient Safety Nancy Brumley Gessling, MSN, CIC Infection Prevention Copper Basin Medical Center

2. CBMC Demographics Polk County – extreme Southeast corner of Tennessee 25 Bed Critical Access, with swing beds 3 bed Emergency Department

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Stakeholder Relationships Who is really affected by the process? Proactive communication Evidence based practice is essential Track, trend, and monitor interventions Share your success

10. 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”

11. 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

12. ASC Data 2008Nasal SwabsMRSA PositivePatient DaysPatient D/C's Jan9528987 Feb11131686 Mar1134577 Apr3225482 May3130588 Jun3029691 Total30101509420

13. ASC Data