INFECTION PREVENTION


following insertion. Barker’s work contrib- uted to a 50% decrease in CLABSIs in 2021 as compared with 2020.


Safe IUC use


Erica Leonard, MSN, RN – BC, CNL, CIC is a preceptor for new IP staff and recently assumed the role of Nursing Assistant Clinical Instructor. She also participates in the Acute Care Council, Nursing COVID Resource Committee and leads the catheter associated urinary tract infection (CAUTI) committee.


Under Leonard’s leadership, the CAUTI committee has achieved the following: •New “Take CAUTI On” campaign to encourage and reward nurses for timely removal of indwelling urinary catheters (IUCs)


•Updated IUC order-set to include selection of evidence-based indication and manage- ment plan for the IUC


•An online CAUTI Prevention Toolkit accessible to all staff


• Updated urine culture order to include indication to help prevent inappropriate culturing of urine


• Regular rounding on patients with IUCs to ensure IP bundle elements are being utilized


• Just in time education to nurses and pro- viders whenever needed


These initiatives have helped decrease inappropriate use and duration of IUCs thus decreasing risk of CAUTI to patients.


C. difficile prevention initiatives Cameron Griffin, BS, MB (ASCP), CIC, Infection Preventionist, leads the C. dif- ficile committee and participates in the Antimicrobial Stewardship Committee to prevent misuse/overuse of antimicrobials. In 221, riffin and the C. difficile commit- tee implemented several new initiatives to help stop transmission and reduce infections: •A bare below the elbows policy, new cleaning and disinfection procedures, and nurse driven CDI protocol allowing nurses to order C. difficile testing based on new or worsening symptoms


•A diagnostic stewardship tool and best practice alert for patients on high-risk antibiotics with a history of C. difficile to prevent recurrence, along with prevention education for new nurses


• Investigation of the potential benefits of an updated testing algorithm with the inten- tion of reduction in detection of C. difficile colonization and resulting inappropriate antibiotic treatment


• IP team collaboration with Environmental Services (EVS) leadership to ensure that EVS staff are trained in IP best practices, and that all cleaning and disinfection products are ideal for keeping patients and


staff safe from transmission of potentially infectious organisms


Hand hygiene success


Carrie Silver, MSN, RN, CNOR, Infection Preventionist, leads the Hand Hygiene and Personal Protective Equipment Committee, and participates in work related to HAI prevention and COVID surveillance and reporting.


Throughout the pandemic, Silver has lev- eraged several hand hygiene technologies to improve compliance. These efforts include: •Implementation of an electronic hand hygiene monitoring system used by over 2,500 employees and capturing over 30,000 hand hygiene events each day


• Use of a hand washing technology to train staff on the correct steps when performing hand hygiene, which has been rolled out to a variety of departments, including EVS and ambulatory clinics


•Updated training materials for use of hand hygiene direct observation collection software that allows staff to collect both hand hygiene and PPE data for analysis and reporting, along with virtual training sessions


Advanced analytics and reporting Kathleen Stewart, MPH, is an embedded Quality Specialist on the IP team. Stewart functions in the role of data analytics and reporting and assists the team with project management, meeting facilitation, and use of data management tools.


Stewart has created compliance reports for everything from hand hygiene to infection prevention bundles, as well as dashboards for quality reporting and keeping goals on task. Stewart also has expertise in regulatory surveys and functioned as a survey coordina- tor during the 2021 Joint Commission survey.


Support across the board


Stephanie Casale, BSN, RN, Infection Preventionist, assists with day-to-day IP work, including CLABSI, CAUTI, C. difficile, and COVID surveillance and reporting. Additionally, Casale has partnered with


the IP team on projects to reinvigorate new employee orientation, hand hygiene educa- tion, and C. difficile mitigation strategies. She has also taken on the role of Inpatient Dialysis expert for which she has developed a tracer to ensure IP best practices are being followed in this area.


“The Dartmouth-Hitchcock Infection Prevention team is one of the hardest work- ing teams that I have ever had the privilege of working with,” said Swain. “Although the work of the team has increased exponentially throughout the COVID-19 pandemic, each team member has continued to work toward hospital acquired infection reduction goals


32 March 2022 • HEALTHCARE PURCHASING NEWS • hpnonline.com


and improvement of patient safety and quality of care.”


A nationwide approach to IP standardization


As health systems continue to grow through mergers and acquisitions (M&A), leaders are challenged to unite clinical and operational stakeholders from across various hospitals in common goals and processes. In 2016, Ascension, one of largest


U.S. health systems, created a new system level position, Senior Director of IP, and hired Lisa Sturm for the role. Sturm was charged with building a system-wide IPpro- gram to connect and engage infection preventionists at 142 Ascension hospitals across 13 major markets and 19 states in the fight against healthcare acquired infec- tions (HAIs). She took a “systems thinking” approach focused on data/analytics, priori- tization and collaboration.


Data and analytics


Gaining a system-wide view of HAIs and then pinpointing opportunities for improve- ment requires a robust data set and analyt- ics that some large health systems may not have. Rather than reinventing the wheel, Sturm worked with the Ascension’s analyt- ics team to leverage the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) HAI tracking system.


Any hospital that requests payment from the Centers for Medicare and Medicare Services (CMS) must report HAIs to the NHSN database. Ascension’s analytics team has provisioning rights to all data submit- ted by the health system’s hospitals. This enabled them to develop dashboards at the national, market, hospital and in some cases unit level (e.g., ICU, NICU) to guide Sturm and her IP and quality colleagues in their efforts.


Prioritization As Sturm states, successfully addressing infections from a system level can’t be done with a “shotgun” approach, rather, she needed a way to prioritize those facili- ties that had the greatest opportunity for improvements. The NHSN features a cumulative attribut- able difference (CAD) calculator that allows users to perform this prioritization. With the tool Sturm can identify high rates for various types of HAIs (e.g., CLABSI, CAUTI, MRSA, C.diff, SSI) across Ascension’s hospitals to determine where it makes most sense to target interventions.


“Let’s say for example on a national level there were 50 central-line blood stream infections (CLABSI) across the health sys- tem in one month, but the standardized


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