4 Cornerstones Environmental Report PICNET 2014 Linda Dempster - PowerPoint PPT Presentation

4 Cornerstones Environmental Report PICNET 2014 Linda Dempster Dr. Elizabeth Bryce Sydney Scharf March 3, 2014

The 4 Cornerstones

• Prevents ARO spread Hand Hygiene • Prevents infection • Prevents ARO spread Environmental • Provides clean equipment Program • Prevents infection • Improves quality Antimicrobial • Reduces mistakes or omissions Stewardship • Decreases adverse events • Alters microbial ecology • Improves quality Standard • Reduces mistakes or omissions Protocols • Prevents infection • Improves patient perception/experience

Key Elements of the 4 Cornerstones Program • A VCH antimicrobial stewardship program to ensure appropriate, cost effective use of antibiotics on the clinical units within our hospitals • An environmental management program to improve clinical equipment surface cleanliness as well as clinical equipment management on each clinical unit • Implementation of a risk-managed approach to the isolation of VRE clients in an effort to support patient flow and reduce unit supply costs • An equipment cleaning program 4

Partners • Aramark • Biomedical Engineering • BISS • CDI Working Group at VGH, Goldie Luong • Clinical Services • FMO • HSSBC • IMIS • Infection Control • Leslie Forrester & Epidemiology Team • Medical Microbiology • Pharmacy • Professional Practice • Simon Tse 5

□ Wall mounted gloves 6

Decluttering Before After 7

Decluttering Cost Template Quantity (per Supplies Cost per unit Waste patient room) $ 22G x 1" Protectant IV 3060 $ 0.26 - $ 3M Brown Compressor Dressing - System 2 $ 5.02 - $ 3M Medipore Dressing Roll $ 6.81 - $ 3M Tape $ 0.62 - $ 3M Tegaderm Film 4" by 4 3/4" (1626W) $ 0.89 - $ 3M Tegaderm Film 6cm by 7cm $ 2.38 - $ Suction Toothbrush $ 2.56 - $ Tegaderm Transparent Film Dressing with Border 3" x 4" $ 1.77 - $ Triumph Sterile Latex Gloves, Powder Free (6) $ 0.70 - $ Yankauer Suction Tube $ 0.60 - Time spent decluttering (in hours) People involved Number of patient rooms Total 0 $ - Total per Unit 8

Milestones: Clean stretcher protocol VGH June 27th 9

RH • MECD- July 2nd 10

RH • EQD opening - August 11

LGH • MECD Program - July 9th • EQD opening - August 20th 12

Wheelchair Amnesty LGH August 30 to September 20 • 15 returned 13

Green Means Clean VGH September 14

Clean bed protocol VGH, LGH 15

Equipment cleaning manual • Inspired by VIHA • Available online October 2013 • Shared with SPH and Saskatchewan HA • Accreditation at RH 16

Environmental Cleaning Outcomes • De-cluttering • Introduction of PPE carts • Introduction of color coded microfiber cleaning cloths and color coded buckets • Equipment management includes cleaning, preventative maintenance, establishing par levels, and ensuring that the right piece of equipment is available and is clean at all times. • Labeling/tagging 17

Color coded housekeeping cart 18

Equipment Management Benefits • Regional inventory, 5 surplus beds and 2 walkers moved - transferred from UBC to VGH. • Savings of approximately $ 5,200 • 8 commodes to LGH $8,000 19

Yellow Gowns BEFORE 20

Yellow Gowns AFTER 21

Personal size hygiene trial 2 units at VGH, ongoing. Now at 6 months. Benefits: 1. Decreased cross contamination 2. Less waste 3. Savings, neutral at 6 months 4. Patient satisfaction 5. Staff satisfaction 6. Non-quantifiable data but qualitatively in favour of proceeding. 22

Decrease VRE patients isolated daily at VGH Before After 7 beds 32 beds 23

Savings: To Date Year Projected Soap-Swap Out $46,435.04 $65,490.00 Lab Savings $64,830.00 Yellow Gowns $154,170.00 Decreased FTE Equipment Program $480,000.00 Decreased Stock Clerk $40,000.00 Linezolid Savings $202,237.00 24

What is antimicrobial stewardship? 25

ASPIRES Antimicrobial Stewardship Program – Innovation, Research and Education for Safety Clinical Care Education Excellence Research Collaboration 26

VGH Data 27

Four Cornerstones VGH: Pre and Post Implementation Total CDI Acquired at VGH (Pre & Post Implementation) 400 375 350 ↓ 30% 300 Total Number of Cases 250 263 200 150 100 50 Sep 2012 - Dec 2013 Jun 2011 - Aug 2012 0 Pre Post 28

Next Steps • Sustain program • Patient rooms, begin cycle again • SOP – dock to dock regional inventory • Audits of MECD Program • Individual Hygiene Packs, regional • Safe/clean hospital – new way of doing business • Green Means Clean • Focus, continued decrease of CDI 29

 Dollars saved  Bed Days saved  Patients protected from CDI 30

Target CDI 31

Questions 32