1. Lou Ann Bruno, MD Chief of Infectious Diseases and Medical Director Of Infection Prevention 2006-2008 NHSN Benchmark Med-Surg ICU: 2.2 222 1

2. Goal: No More Than 1 MRSA-VAP Case During the First 6 Months of 2009 No VAP 2006-2008 NHSN Benchmark Med-Surg ICU: 2.2 Active Surveillance Initiated 2/6/07 222 1

3. Multidisciplinary Team Nursing – Frontline staff – Unit manager – Leadership Respiratory Therapy – Frontline staff – Manager Infection Prevention – IP – Medical Director Environmental Services – Frontline staff – Manager Respiratory Care Management Infection Prevention Practices – Compliance with hand hygiene and contact precautions Environmental Disinfection Cleaning Please refer to the Cambridge Health Alliance storyboard for additional details

4. Actions Multidisciplinary audits for compliance 24/7 – Hand hygiene – Contact precaution – HOB elevation Feedback/Coaching New signage – HOB elevation – Order for donning & removing PPE Vent bundle order sheet and sedation vacation protocol laminated & attached to every vent Revised policy for HME & in- line suction catheter changes Developed oral care policy Retrained environmental service staff Trained respiratory therapists re: procedure for vent cleaning Implemented a process for monitoring disinfection cleaning Developed patient/family educational materials Clarifying responsibility for cleaning of all patient care equipment Purchased larger trash barrels for patient rooms Please refer to the Cambridge Health Alliance storyboard for additional details

5. Lessons Learned Beneficial to engage frontline staff, managers, site leadership and physicians Active intervention (coaching) is effective Reserve time to meet on a regular basis and have leadership communicate that the project is an institutional priority Communicate and display process and outcome measures to all stakeholders Beneficial to participate in this Coalition effort