The campaign began in 2013 and is ongoing. “Prior to 2013, Faxton St. Luke’s began a C. diff-reduction campaign consisting of proper contact precautions during and after treatment, a hand- hygiene program, use of bleach for terminal and daily cleaning of all C. diff rooms, and heightened awareness of the issue,” said Bernard. “Despite best practices in place for reducing C. diff, the rate remained stagnant.”

In June 2013, the Surfacide automated multiple emitter UV-C disinfection system was added to their bundle of interventions. Along with increased attention to prevention efforts, they began to see a reduction in C. diff rates. “The Surfacide Helios system was integral in our ultimate reduction in C. diff infections,” stated Bernard. “Other interventions were simply unable to result in a reduction in our infection rate, but the addition of the Surfacide Helios system resulted in a 41 percent reduction in rates in the first year alone.” Departments working together to implement this campaign against C. diff included leadership, infection prevention, nursing, the transfer center, and EVS. The admin istration and nursing depart ments were initially concerned about interruption in bed flow, so “it was important to demonstrate that the time to perform the UV disinfection would not impact the bed flow by a tremendous amount and that the benefits outweighed the risks,” said Bernard. “Com- munication be- tween infection prevention and EVS, and proper deployment of the UV disinfec- tion system were key.” Results: The C.

Surfacide Helios system

diff infection rate at the end of the study was just

under 10 per 10,000 patient-days. “The rates have remained at, or below, that level, with our bundle of best-practice interventions and continued use of the Helios UV disinfection system,” said Bernard. “Our rate at the end of 2017 was 8.5 infections per 10,000 patient-days.”

Elmhurst Hospital Elmhurst, IL

Elmhurst Hospital is a community-based acute-care hospital licensed for 259 private patient rooms. Elmhurst Hospital is nation- ally recognized for its heart failure program, state-of-the-art cancer center, emergency services, technologically advanced surgical services, and level 2E nursery with all private rooms. What they did: “Elmhurst Hospital’s SIR for hospital-onset C.

diff was 1.346 in 2015,” said Annemarie Schmocker, RN, BSN, CIC. “Reducing the hospital-onset C. diff infections became a top priority for the board, senior leadership, and part of the value- based healthcare initiative. Elmhurst Hospital implemented a comprehensive plan of action end of year 2015 into 2016. “Elmhurst Hospital Senior Leadership fully supported invest- ing in a high-level disinfection (HLD) system for patient rooms,” continued Schmocker. “From the beginning, Elmhurst Hospital included all key players when researching the HLD system to pur- chase, demo, and implement. Employee feedback was considered throughout the review of HLD systems currently on the market. A comparison analysis of systems (hydrogen peroxide technology versus UV technology) was completed by both housekeeping and infection control. The teamwork and communication that occurred


throughout this tedious review prevented any concerns on how this process would be implemented throughout the hospital.” El- mhurst Hospital began using the Altapure High Level Disinfection System in March 2016. They also built and initiated a protocol within their electronic medical record (EMR) promoting antimicro- bial stewardship and diagnostic steward- ship, (i.e., timely and appropriate testing for C. diff.) “Lastly,” said Schmocker, “the infection preventionists implemented an active case-management plan for patients with an order placed for C. diff testing.” “The Altapure High

Level Disinfection Sys- tem has been an out-

Altapure High Level Disinfection System

standing addition in mitigating the risk of environmental contamination of patient rooms,” maintained Schmocker. “A daily communication is sent by Infection Control via email of all patient rooms requiring Altapure HLD.” The patient rooms are marked to receive Altapure with a blue ‘A’ icon within the bed-tracking system built within the EMR. Results: “Beginning in July 2016, we lowered our SIR to less than one and have sustained it for over 1 ½ years now,” said Schmocker. “Our lowest SIR has been 0.452; our highest, 0.998. We continue to strive for zero hospital-onset infections.”

Conquering CAUTI and CLABSI

University of Maryland St. Joseph Medical Center Towson, MD

University of Maryland St. Joseph Medical Center is a 224-bed, nonprofit, regional medical center and a member of the University of Maryland Medical System. Major service lines include a com- prehensive cancer center, cardiac surgery, orthopedic surgery, and maternal child health services. What they did: Lisa Hargett, MPH, CIC, Infection Prevention Director, and Theresa Anderson, MS, RN, CIC, Senior Infection Prevention Coordinator, related the story of their successful campaign to reduce catheter-associated urinary tract infections (CAUTIs). “CAUTI reduction progress has been made through standardization and implementation of evidence-based practices,” said Hargett and Anderson. “Despite continuous efforts to reduce infections, the medical-surgical intensive care unit (MSICU) had opportunities for improvement,” noting the MSICU had 9 CAUTIs in fiscal year (FY) 2015, with SIR of 1.79.

“In November 2015, a new process for managing bowel incon- tinence and enhancing perineal and urinary-catheter care was implemented,” explained Hargett and Anderson. “The interven- tions included baby wipes for incontinence care and Theraworx (Avadim Technologies) for perineal and urinary-catheter care. Theraworx is designed to be applied to prevent contamination and to create a ‘zone of inhibition.’” This product is used during pre- and post-insertion of urinary catheter, with catheterized patients, for bowel incontinence episodes, during the daily chlorhexidine gluconate bath, and prior to straight catheterization. They in- creased care from once to up to six times per day, based on the duration of the catheter.

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