1. Merrimack Health Group Marlborough Hills Health Care Center

2. Objectives Identify at least 3 practical ways to improve overall facility infection control State at least 3 interdisciplinary measures to reduce the incidence of CDI Identify at least 3 practical ways to implement environmental changes in your facility

3. How we Began our Journey… MA Senior Care Newsletter CDI Hospital SNF Collaborative Contacted MA Coalition for Prevention of Medical Errors Our Marlboro facility assigned to partner with MWMC First SNF-Hospital CDI Collaborative meeting Additional Collaborative meetings and conference calls November 2011

4. MWMC-SNF CDI Team: Individual Team Assessment Prepared by MWMC Infection Control Practitioner Mechanism to start our in house assessment Identified facility team members and role in facility Reassessed the number of cases of CDI last year Reviewed corporate nursing & infection control policies and procedures Examined environmental supplies and practices Assessed whether visitors follow proper infection control guidelines

5. The Team Administrator DON Senior Director of Clinical Services for Merrimack Health Group Regional Clinical Consultant for Merrimack Health Group SDC Case Manager NP Director of Rehab Unit Managers Director of Social Service Director of Dietary Activities Director Director of Maintenance Director of Environmental Services Front line staff: CNA’s from LTC and subacute units

6. In House Meetings Initially whole team met every 2 weeks Interdisciplinary subcommittees established Infection Control Committee Education Committee Environmental Committee Healthy Hands & Aesthetics Committee Antibiotic Stewardship Committee Much progress made and was tested in February when we had a GI outbreak… stay tuned

7. Infection Control and Education Committees New evidenced based corporate policies and procedures with clinical competencies Cdi Contact Plus Precautions Hand Hygiene-Glitter Bug a huge hit! Alcohol based hand rubs Soap and water MHG Hand washing & CDI Needs Assessment Expanded upon MWMC questionnaire Distributed to all Directors of Nursing/SDC’s Results/assessment to Regional Clinical Consultant DON/SDC inserviced before p&p rolled out in facilities

8. Infection Control and Education Committees: MHG Hand washing & CDI Needs Assessment Expanded upon MWMC questionnaire Distributed to all Directors of Nursing/SDC’s Guide to assess if f acility compliant with newest p&p Review education, audits, equipment, supplies Review environmental services Assess antibiotic usage in the facility Results/assessment to Regional Clinical Consultant DON/SDC then educated prior to implementation of new hand washing and cdi programs

9. Infection Control and Education Committees Started reviewing all infections daily @ skilled meeting Completed inventory of infection control equipment in facility Contact Precaution & Contact Plus signs revised “Report to Nurse” stop signs revised Ordered disposable equipment for CDI patient rooms Blood pressure cuffs Stethoscopes Thermometers Glucometers Gait belts different color Instituted neon green colored interdepartmental infection communication forms Learned effectiveness of cohorting patients with cdi

10. Infection Control and Education Committees Based interventions & programs on the “Practice Opportunities for CDI Prevention” hand out “Jasper Palmer Method” as seen on Youtube Developed CDI FAQ brochures Staff version also available in Spanish & Portuguese Patient and visitor version Developed Infection Control FAQ brochure Put into patient welcome bags Community outreach: Q & A Cable program for Marlboro Seniors

11. Infection Control and Education Committees Education for environmental services Translators were available at time of inservice Communication Cards created Facilitate clear communication between departments Spanish and Portuguese with English equivalent Mandatory Inservice Fair for all staff New P & P’s Competencies were completed

12. Environmental Committee SDC audited housekeeping & laundry Assessed practice opportunities for cdi prevention Equipment Environment Cleaning solution options Implemented “CDC environment checklist for monitoring terminal cleaning:” Helped to identify high touch room surfaces Microfiber mops purchased Still exploring UV disinfection system Bleach wipes readily available

13. Healthy Hands and Aesthetics Committee Hand wipes for patients to use before meals Hand washing at patient activities Hand washing audits Fun & unique hand washing framed signs Used ideas from collaborative Commode liners very effective Containing the cdi Reduced odor Staff ease of use

14. Antibiotic Stewardship Committee Pharmacy antibiotic records reviewed Collated meds by prescriber; then used to identify: Prescribing patterns Opportunities for re-education Number of patients with cdi Initial Recurrent Results given to DON’s/SDC’s for their review

15. What happened in February… Many patients admitted with gastroenteritis Subsequent new cases of concomittant cdi CDC –gastroenteritis predisposes patients to cdi! Put all departments new skills to the test Yellow gowns became a fashion statement  Found that cohorting was an important part of eradicating cdi

16. After the “invasion…” Only 2 cases of facility acquired cdi (antibiotic use) We continue to meet as a team monthly Track cdi as a part of our CQI We are so appreciative for all that we have learned from being a part of the CDI collaborative!

17. Our Journey continues…& We wish you luck with yours! Questions? Comments?