1. C. Difficile Prevention Partnership Collaborative: Bringing Together Hospitals and Skilled Nursing Facilities Audio Conference Call October 25, 2011 www.macoalition.org

2. Agenda Introduction to C. Difficile Prevention Collaborative CDI Management in Healthcare Facilities: Preview Successful Infection Prevention Through Hospital/Long Term Care Collaboration Learning By Looking, Asking Susanne Salem-Schatz, Sc.D. Collaborative Director Gail Bennett, MSN, RN, CIC Sally Hess, MPH, CIC Fletcher Allen Health Care Lisa Gallant, RN Green Mountain Nursing Center Carolyn Terhune, MT (ASCP), CIC Fletcher Allen Health Care Sharon Benjamin, Ph.D. Collaborative Consultant 2

3. Background  Increasing concern about multi drug resistant organisms including clostridium difficile (CDI)  2 year partnership between Coalition and DPH with CDC funding to support CDI prevention in acute care hospitals  Opportunity to expand work to include settings across the continuum of care (bugs don’t pay attention to facility boundaries!) 3

4. Our Team Massachusetts Coalition for the Prevention of Medical Errors  Paula Griswold, MS Executive Director  Susanne Salem-Schatz Sc.D. Collaborative Director Massachusetts Senior Care Foundation  Helen Magliozzi, RN, BSN Director of Regulatory Affairs  Laurie Herndon, MSN, GNP-BC ANP-BC, Director of Clinical Quality Masspro Denise Selfridge, LPN, CPHQ Massachusetts Department of Public Health  Al DeMaria, MD, Medical Director, Bureau of Infectious Disease  Eileen Mchale BSN, HAI Coordinator  Nora McElroy, MS, Epidemiologist Expert Consultants  Gail Bennett, MSN, RN, CIC Infection Prevention  Sharon Benjamin, Ph.D. Organizational Change 4

5. Your Teams Skilled Nursing Facilities  Staff person in charge of infection control  Administrator  Director of nurses  Environmental services manager/staff  Front line staff (nurse, CNA)  Social worker (or whoever manages your admissions)  Medical director or nurse practitioner  Consultant pharmacist Hospitals  Infection Preventionist  Environmental services staff  Nursing representative  Microbiologist  Infectious disease specialist  Pharmacist  Case Management (or whoever manages your care transitions) 5

6. To Do List: Send a List of Your Team Members:  Name, role, and email address  Identify team leader, measurement contact  If someone does not have access to email on a regular basis, let me know so we can work out a communication system. (Susanne Salem-Schatz, sss@hcqi.com) 6

7. Program Preview October 2011 – July 2012 Program-wide Events Kickoff Call……………………………. Statewide Learning Sessions……………. Regional ½ Day Workshops……………. Antibiotic Stewardship………………… Cluster Activities To be determined by cluster participant Measurement Monthly reporting of CDI rates Tracking of hospital admissions over time Dates October 25, 2011 November 15, 2011 June 2012 January 2012 April 2012 January2012---? 7

8. What We Will Bring  Content expertise  Process expertise  Program structure including opportunities for shared learning and measurement  Coaching and support for practice changes and reporting  Desire to learn from the experts on the front lines and to share discoveries across the collaborative 8

9. What We Hope You Will Bring  Expertise from the front lines of care  A strong desire to improve infection prevention and patient outcomes  Readiness to learn new approaches to test engage staff at all levels and test changes in your organization  Willingness to make time, work hard and have some fun along the way 9

10. Will, Ideas, Execution  Will: the desire to make changes and improve care for patients and residents  Ideas: includes both best practices or expert content, AND your expertise about how to make change in your organization  Execution: purposeful efforts to engage staff, identify changes to try, test and implement changes including measurement and reflection 10

11. Clostridium difficile Management in Healthcare Facilities Preview November 15, 2011 Gail Bennett, RN, MSN, CIC 11

12. Topics to be Discussed Clostridium difficile inection (CDI) Colonization vs. infection Risk factors Antibiotics most frequently associated with CDI Rates of recurrence Testing for CDI Treatment 12

13. Strategies for Preventing Transmission Hand hygiene Hand hygiene Contact precautions Contact precautions Identification of cases Identification of cases Environmental disinfection Appropriate use of antibiotics 13

14. 14 With Emphasis on C. difficile in Acute vs. Non-acute Settings

15. Examples of Challenges in Managing CDI Cases Maintaining appropriate contact precautions Rooming arrangements LTC residents socializing outside the room Environmental decontamination Using recommended practices Monitoring compliance …and others 15

16. Looking forward to meeting with you – November 15, 2011!

17. The Vermont MDRO Prevention Collaborative: A Hospital & Long Term Care Facility Partnership Sally Hess, Infection Prevention Manager, Fletcher Allen Health Care Lisa Gallan t, Infection Control, Green Mountain Nursing Center Carolyn Terhune, Infection Preventionist, Fletcher Allen Health Care

18. Hospitals and long-term care facilities serving the same community, working together to form a larger team. What is a Healthcare Cluster? Hospital (H) Long- Term Care (L) Healthcare Cluster Team (H) (L) Burlington Cluster = Hospital + 6 LTC 18

19. 19

20. Burlington Cluster Accomplishments  Evaluated current LTC and acute care practices re: isolation & patient placement.  Reviewed housekeeping practices, discussed best practices.  Shared an environmental services best practice checklist.  Developed an inter-facility communication/transfer form.  Revised the hospital Transition of Care form to include all key elements of the transfer form.  Reviewed the California enhanced precautions document – discussed & compared local practices and recommended changes to the State of Vermont – Goal is to “publish” a Vermont document. 20

21. Burlington Cluster Accomplishments  LTC IP education, networking & open forum with Q&A.  Identified infection prevention learning needs, developed and presented LTC staff education.  MRSA screening on admission to hospital.  CHG bathing on admission to hospital.  LTC facility education and enrollment in NHSN.  Successfully transmitted hospital MDRO and C. diff data to NHSN via WHONET. 21

22. Statewide Challenges  Different cultures / approaches  Lack of administrative engagement  LTC IP “wears many hats”  Limited personnel resources / time  Staff turnover  Little control over environmental services  Limited computer skills & access  Implementing changes in all facilities in a cluster – not one-size-fits-all 22

23. Statewide Successes  Networking…..LTC & Acute Hospital.  Improved communication between facilities.  Sharing information, knowledge & policies  Inter-facility transfer form  Recognizing Environmental Services needs.  Physician involvement in cluster meetings and discussions about interventions. 23

24. Statewide Successes  Enhanced standard precautions.  MDRO patient/family educational information.  Active selective surveillance for MRSA.  Hand hygiene observations.  Evaluation algorithm for suspected UTIs.  Statewide NHSN training. 24

25. GOOD LUCK! 25

26. Learning by Looking, Asking Today’s call is to launch our first important activity: Hospitals visit one of your Skilled Nursing Facility partners Sharon Benjamin, Ph.D., Collaborative Consultant 26

27. Purpose of Visit  Your visit is to explore and understand the overlaps and differences between hospitals and skilled nursing facilities (SNFs)  Start creating a map of potential improvements: so hospitals can improve hospital practice and SNFs can improve SNF practice  Practice seeing with “beginners’ mind”  Bring back ideas to share 27

28. What this Visit is NOT An accreditation visit We are not visiting to judge, teach or correct We are not visiting to confirm our existing beliefs 28

29. What To Do on theVisit  Take a tour of the facility as an interested guest  If possible, visit patient rooms and baths, and shower rooms, spend time in the cafeteria and physical therapy  Notice how structure, process and needs shape practice and behavior  Take notes but not pictures 29

30. What to Ask Questions of genuine curiosity :  Why do you do that? Why? Why? Why?  How does that work?  Can you show me?  Can you tell me what’s happening here?  Is this normal?  Is this unusual? 30

31. What to Take with You √ Curiosity (so that when you notice yourself judging instead of learning you can get more curious) √ Wide open eyes and ears √ Open hearts and minds √ Notes handout √ Notebook (for jotting down questions, ideas things you notice, wonder about and things that concern you) 31

32. What to Bring Back To help you organize your notes we’ve created a handout (see attached) Notes: When, Where, Who & What What: Be objective. What do you see, hear, witness, experience? Was there a moment that captured the experience? Avoid interpretations. So What? Why is what you are seeing important? Now What? What hunches for actions or prototypes do your observations spark? 32

33. Final Thoughts  Be a good guest – make it easy for your hosts!  Stay focused on patient needs  Try to see naïvely with “childlike eyes.”  Be wildly curious asking, “why, why, why,  how, how, how, & can you show me?”  Practice humility. You are studying at the feet of the people who can make and sustain critical changes. 33

34. Next Steps  Cluster Contact Information  Current  Expanded  Schedule Measurement Call  Register for November 15 th Workshop  http:www.regonline.com/cdifficilepreventionworkshopnovember152011  Questions?  Registration: Fiona Roberts, froberts@macoalition.org  Everything else: Susanne Salem-Schatz, sss@hcqi.com 34