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The Vermont Multidrug-Resistant Organism Healthcare-Associated Infection Prevention Collaborative


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Title: The Vermont Multidrug-Resistant Organism Healthcare-Associated Infection Prevention Collaborative

The Vermont Multidrug-Resistant
OrganismHealthcare-Associated Infection
Prevention Collaborative
A Hospital and Long Term Care
FacilityPartnershipOverview of Our 1st Year
Sally Hess, MPH, CIC FAHC, Infection Prevention
Manager Carol Wood-Koob RN, CICHAI Prevention
Coordinator Patsy Tassler Kelso, Ph.D State
Epidemiologist for Infectious Disease
Presentation Outline
  • History of the project
  • Description of the collaborative approach
  • Review of successes and challenges
  • Focus on the Burlington Cluster

  • Healthcare-associated infections (HAIs) are a
    significant cause of morbidity and mortality in
    the US.
  • 1.7 million infections/year
  • 99,000 deaths/year
  • HAIs are the most common cause of adverse events
    in healthcare with direct medical costs 35 45
    billion (adjusted for 2007 inflation).
  • Impact of infections in long-term care Unknown?

  • ARRA funding provided CDC support for state
    health departments in HAI prevention.
  • VDH, VPQHC, and BISHCA collaborated on Vermonts
  • Vermont 1st state to publicly report infection
    rates using the National Healthcare Safety
    Network (NHSN).
  • Vermont 4th state to report hospital-specific

History (continued)
  • ARRA grant supported
  • HAI Prevention Coordinator at VDH
  • Development of state plan for HAI prevention
  • NHSN data validation
  • HAI prevention collaborative

Vermonts Collaborative Vision
  • For acute and long-term care facilities to work
    together toward the prevention and elimination of
    healthcare-associated infections.

CDC Called
  • John Jernigan your inclusion of long-term care
    in HAI prevention is the way to go! Why dont you
  • Focus on multidrug-resistant organisms (MDRO)
  • Submit MDRO data electronically to CDC
  • CDC will provide help from WHONET for electronic
    reporting from hospital labs.

What is a MDRO?
  • Bacteria resistant to certain groups of
  • Methicillin-Resistant Staphylococcus aureus
  • Vancomycin-Resistant Enterococcus spp. (VRE)
  • Cephalosporin-Resistant Klebsiella
  • Carbapenem-Resistant (CRE) Klebsiella spp.
  • Carbapenem-Resistant (CRE) E coli.
  • Multidrug-Resistant (MDR) Acinetobacter spp.

What is a Healthcare Cluster?
  • Hospitals and long-term care facilities serving
    the same community, working together to form a
    larger team.

  • Collaborative
  • Hospitals
  • 13 in VT
  • 1 in NH

  • Collaborative
  • LTC Facilities
  • 40 in VT

  • Patient/Resident Transfers as Reported by

Healthcare Clusters
  • Geographically local groups of acute and
    long-term care facilities
  • Share patients and laboratory
  • Group decision-making about what interventions
    will work for them
  • Peer to peer learning and support

MDRO Prevention- The CDC Challenge
  • Innovative interventions to prevent and control
  • Communication between facilities
  • Modified contact precautions
  • Environmental cleaning
  • Hand hygiene education, observations
  • Antimicrobial stewardship
  • Chlorhexidine (CHG) use
  • Promoting good urinary catheter practices

Learning Sessions
  • September 2010
  • January, May, September 2011
  • Full-day meetings included
  • CDC speakers
  • Vermont subject matter experts
  • NHSN guidance
  • Updates from clusters and facilities

Assessment of Infection Control Programs in LTC -
  • A CDC survey was used to assess Infection Control
    (IC) programs in LTC.
  • Characteristics of person responsible for IC
  • RNs 71 (22/31)
  • Certified in Infection Control 0 (0/31)
  • No specific infection control training 74
  • Coordination of infection control
  • Full time 10 (3/31)
  • Part time 90 (28/31)

Cluster LTC Coaching
  • Phone outreach by VDH and VPQ staff
  • VDH and VPQ attending cluster meetings
  • Help with NHSN enrollment
  • Resource material and educational tools provided
    for LTCF

Collaborative Successes
  • Enhanced knowledge of infection control best
  • Improved communication between facilities
  • Sharing information, practices, policies
  • Inter-facility transfer form
  • Recognizing environmental services needs
  • Physician involvement in cluster meetings and
    discussions about interventions

Collaborative Successes (cont.)
  • Implementation of enhanced standard precautions
  • MDRO patient/family educational information
  • Active surveillance for MRSA
  • Hand hygiene observations
  • Clinical evaluation algorithm for suspected
    urinary tract infection (UTI)
  • Training on NHSN enrollment and event

Collaborative Challenges
  • Little control over environmental services
  • Implementing changes in all facilities in a
    cluster not one-size-fits-all
  • Different cultures / approaches to change
  • Lack of engagement of facility administration
  • Limited personnel resources / time
  • Staff turnover
  • Limited computer skills and access

Reporting MDRO Events to NHSN
  • All 13 VT hospitals enrolled in NHSN
  • 20 LTC enrolled in NHSN
  • WHONET is working with Vermont hospitals to
    electronically transmit laboratory ADT data
  • One of the 1st in the nation to do this!
  • 8 hospitals sending data electronically so far
  • NHSN is developing a new LTC component
  • Vermont facilities are ahead of the rest of the
  • In many clusters the hospital IP will report MDRO
    data for the long-term care facilities

  • Work Flow for LTCF LabID Events

MDRO Events from LTC..using NHSN. A Vision for
the Future.
  • Lab data submitted electronically to WHONet by
    acute care (AC).
  • WHONet to identify LabID Event candidates for AC
    and LTCF.
  • Lab data must include a unique identifier for
    each LTCF i.e. location code
  • Event candidates identified using NHSN inclusion
    exclusion criteria.
  • WHONet Candidate list excel spreadsheet.
  • AC IP will filter the candidate list specific to
    each LTCF in their cluster.
  • AC IP sends candidate list to the LTC IP.
  • FAX, secure file transfer, mail or other agreed
    upon HIPAA compliant method.
  • LTC IP completes LabID event form for each
  • Lab ID Event form Monthly Monitoring forms sent
    to CDC (need to get specifics from Nimalie on how
    this could be done).

Moving Forward
  • Ongoing cluster meetings
  • LTCFs that arent participating in HAI
    Collaborative can attend cluster meetings, take
    advantage of collateral benefits (e.g. transfer
    form, CHG bathing)
  • Some clusters already going beyond scope of HAI
  • Addressing other organisms
  • Including additional stakeholders (EMTs)
  • Monthly data transmission to NHSN

Moving Forward (continued)
  • Implementing successful interventions across the
  • Additional learning sessions
  • Subject matter experts (e.g., antibiotic
  • Change management skills training
  • QIO support
  • UVM student projects
  • RN to BS Program
  • Department of Medical Laboratory and Radiation
  • Residential Care infection prevention training

Infection Preventionists Unite!
  • Long-term care IPs invited to join
  • First meeting of larger group in April 2011
  • Joint VT/NH infection prevention meeting
    September 2011

Sharing Vermonts Successes
  • CDC Safe Healthcare Blog
  • CDC 2010 HAI Grantee Meeting
  • CDC 50-state conference call
  • 2011 Council of State and Territorial
    Epidemiologists Conference
  • Many more to come

Burlington Cluster
  • Fletcher Allen
  • Vermont State Hospital
  • Birchwood Terrace Nursing Home
  • Burlington Health and Rehab Center
  • Green Mountain Nursing Center
  • Starr Farm Nursing Center
  • Wake Robin

MDRO Burlington Cluster Goals Identified at the
last Vermont Healthcare Infection MDRO
Collaborative - Learning Session 3
  • Goal 1 Cleaning protocols are followed by
    housekeeping contractor on transfer and
    discharge, and daily cleaning
  • Measure Surfaces will be audited 2-3 audits per
    week and protocol will be followed 90 of the
  • To Do Each facility will review the cleaning
    protocol for their facility. Need to develop and
    audit form for each facility
  • Follow-up Facilities will provide feedback in a
    non-punitave way to their contractors
  • Goal 2 Chittenden cluster will be enrolled in
    NHSN by the next learning session.
  • Measure 100 enrolled
  • Goal 3 Standardize the transfer process to and
    from acute and long term care.
  • Measure Audit process for 2 transfers in or out
    each week completed per protocol 90 of the time
  • To Do Standardize transfer form, Finalize and
    implement workflow transfer process, develop an
    audit form.
  • Goal 4 Fletcher Allen Health Care, in
    collaboration will develop an Infection
    Prevention education program for LTC facilities
  • Measure Customer feedback surveys 90
  • To Do Presented at least once at each LTC
    facility before the next learning
    session. Develop feedback survey

Accomplishments Next Steps
  • Evaluated current LTC and acute care practices
    re isolation patient placement
  • Reviewed housekeeping practices
  • Created an environmental services checklist
  • Developed an inter-facility communication/transfer
  • Revised the current FAHC Transition of Care form
    to include all key elements of the transfer form
  • Reviewed the California enhanced precautions
    document recommended changes to the State
  • Developed infection prevention curriculum
    presentation for annual LTC staff education

Accomplishments Next Steps
  1. MRSA screening on admission to FAHC
  2. CHG bathing on admission to FAHC
  3. Successfully transmitted hospital MDRO and C.
    diff data to NHSN via WHONET
  4. Enrollment of LTC facilities in NHSN
  5. NHSN MDRO LabID education
  6. LTC MDRO and C. diff data to NHSN
  7. LTC infection prevention open forum with QA

By demonstrating success as a region, Vermont can
serve as a model for MDRO prevention
nationally. John A. Jernigan MD MS
(CDC/CCID/NCPDCID) Deputy Chief, Prevention and
Response Branch Centers for Disease Control and