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483 A Quality Improvement (QI) Initiative to Reduce Outbreaks at The Ottawa Hospital

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Kathryn N. Suh, MD, FRCPC, MSc , The Ottawa Hospital, Ottawa, ON, Canada
Michele Larocque-Levac, BScN , The Ottawa Hospital, Ottawa, ON, Canada
Josee Shymanski, BScN, CIC , The Ottawa Hospital, Ottawa, ON, Canada
Teresa Seguin, BScN , The Ottawa Hospital, Ottawa, ON, Canada
Elaine Lariviere, BScN , The Ottawa Hospital, Ottawa, ON, Canada
Natalie Bruce, MScN, CIC , The Ottawa Hospital, Ottawa, ON, Canada
Paul Zwicker , The Ottawa Hospital, Ottawa, ON, Canada
Virginia R. Roth, MD, FRCPC , The Ottawa Hospital, Ottawa, ON, Canada
James R. Worthington, MD, FRCPC , The Ottawa Hospital, Ottawa, ON, Canada
Linda Hunter, MScN , The Ottawa Hospital, Ottawa, ON, Canada
Background:

Transmission of healthcare-associated infections (HAIs) in acute care settings is often multifactorial. In outbreaks, simultaneous implementation of many measures can be effective, but measures are often not sustained. From 2004 - 2008, 2 acute-care inpatient medicine units at The Ottawa Hospital experienced 7 MRSA outbreaks (79 patients), and 4 C. difficile outbreaks (15 patients).

Objective:

1) identify factors leading to recurrent outbreaks on these units; 2) prioritize areas for improvement related to infection control (IC) practices; 3) develop and implement solutions.

Methods:

A multidisciplinary QI team included staff from the clinical units (Clinical Managers, physicians, front-line nurses, support staff), Infection Prevention and Control, Quality and Patient Safety, Environmental Services (ES), Logistical Services (LS), and Administration. An affinity exercise identified priorities for improvement. Members worked to identify objectives, tasks, activities and indicators for success for each priority. 

Results:

Multiple contributing factors were identified. Key problems included: 1) insufficient supplies to comply with IC best practices and policies; 2) suboptimal communication regarding the need for isolation for patients transferred from the Emergency Department (ED); 3) lack of clarity around responsibility for cleaning of shared patient-care equipment; 4) suboptimal awareness of IC best practices among all healthcare providers. The following were achieved: 1) the number of isolation gowns required for patients on Contact Precautions was determined (30 gowns/isolated patient/24 h); 2) a method to ensure that the supply of gowns was sufficient was developed, piloted, and implemented; 3) an IC screening tool was included in a new ED Transfer of Care and Accountability Form, and implemented; 4) electronic flagging of isolated patients, with access expanded to include ES and LS, was enhanced; 5) corporate procedures / policy for cleaning rolling stock and shared patient-care equipment were developed and implemented; 6) new user-friendly signs for PPE use were developed. Efforts to increase education and awareness of IC practices are ongoing. The two units have not had an MRSA or C. difficile outbreak since 2008.

Conclusions:

Multiple factors contributing to outbreaks on these units were identified. Representation from all occupational groups was essential for identifying areas for improvement, and developing processes and tools to improve practice. Front-line staff were engaged in making self directed-improvements and changing practice; support from Administration was fundamental for facilitating corporate change. Small changes can lead to significant and sustained improvements in patient outcomes. The success of this multidisciplinary approach to improve IC practices should serve as a model for future QI initiatives.