The University of Texas Health Center
Infection Control Collaborative
Jan Evans Patterson MD MS
Associate Dean for
Quality & Lifelong Learning
Work supported by UT System, UTHSCSA, VA
Educating for Quality Improvement & Patient Safety
What is a Collaborative?
Features
1) A specified topic with variations in care or gaps between
current and best practice,
2) Clinical and QI experts provide ideas and support, sharing
knowledge and best practice,
3) A critical mass of multiprofessional teams from multiple
sites willing to improve and share,
4) Setting clear and measurable targets, collecting data, and
testing changes on a small scale to learn by doing, and
5) Collaborative process involving structured activities.
Interprofessional collaboration is critical
to optimize safety and quality.
Specified Topic
1) A specified topic with variations in care or
gaps between current and best practice
Control and prevention of multi-drug
resistant organisms
Clinical & QI Experts Sharing
2) Clinical and QI experts provide ideas and
support, sharing knowledge and best
practice.
• Topics
–
–
–
–
Hand hygiene compliance
2009 H1N1 best practices
MRSA prevention
Isolation compliance & environmental cleaning
Clinical & QI Experts Sharing
3) A critical mass of multiprofessional teams
from multiple sites willing to improve and
share.
Co-Investigators and Collaborators
University of Texas Health Science Center at San Antonio
University Health System (UHS) and South Texas Veterans Health Care System (STVHCS)
Jan Patterson, MD (PI), Professor and Healthcare Epidemiologist, UHS; CS&E course director
Beth Ann Ayala, MT(ASCP), UHS Infection Preventionist
James Lewis, PharmD, UHS Infectious Diseases Pharmacist
Jose Cadena Zuluaga, MD, STVHCS Healthcare Epidemiologist
Patti Grota, RN, MSN, STVHCS Infection Preventionist
Kelly Echevarria, PharmD, STVHCS Infectious Diseases Pharmacist
Edna Cruz, RN, (Consultant) STVHCS Quality Improvement and CS&E Instructor
Amruta Parekh, MD, MPH, UTHSCSA Educational Development Specialist, CS&E course
Letti Bresnahan, MBA, UTHSCSA Project Coordinator, CS&E course
UT Health Science Center at Houston
Luis Ostrosky-Zeichner, MD (Co-I); Professor of Medicine and Medical Director, Hospital Epidemiology
and Infection Control, Memorial Hermann Hospital
Virgie Fisher, CIC, Infection Preventionist
Edgar Rios, PharmD, Pharmacist
Kathy Luther, RN (Consultant), CS&E course
Co-Investigators and Collaborators
UT M.D. Anderson Cancer Center
Roy F. Chemaly, MD, MPH (Co-I) Associate Professor of Medicine, Director of Infection Control Program,
Healthcare Epidemiologist
Cheryl Perego, MPH, Infection Preventionist, Supervisor, Infection Control Program
Linda Graviss, MT(ASCP), Senior Infection Control Preventionist,
Doris Quinn, PhD (Consultant), CS&E course director
UT Medical Branch at Galveston
Glenn Mayhall, MD (Co-I), Professor of Medicine, Healthcare Epidemiologist
Jennifer Baer, RN, MS, CPHQ, Quality Improvement
Pam Falk, RN, CIC, Infection Preventionist
University of Texas Southwestern Medical School
James Luby, MD (Co-I); Professor & Hospital Epidemiologist, Zale Lipshy Hospital, University Hospital
Doramarie Arocha, MS, MT(ASCP), Infection Preventionist, University Hospitals
William Tharpe, PharmD, Pharmacist
Pranavi Sreeramoju, MD, MPH (Co-I); Assistant Professor and Healthcare Epidemiologist,
Parkland Health & Hospital System
Thomas Button, RN, CIC, Infection Preventionist, Parkland Health & Hospital System
Metrics and Testing Change
• 4) Setting clear and measurable targets,
collecting data, and testing changes on a small
scale to learn by doing.
Metrics: Infection Control Practices
Hospital
1
2
Infection Control Practices
MDRO line list
Anti-biogram
Active Surveillance
Cultures for MRSA
Yes
Yes
Yes
Yes
No (pilot in Head &
NHSN
(Y/N)
Y (begun Nov 09
Ratio
ICP:beds
1:100 (also have >1
Neck pts)
Pedi ICU CRBSI)
million outpt
visits/yr)
Yes adult ICU PICU
pending
1:200
Yes In ICUs and 2
Y: CRBSI and VAP for
wards
adult ICUs
1:110 operating
beds or 1:135 total
NICU
3
MRSA, VRE
Yes
beds
4
Yes
Yes
Yes all acute care
No
5
Yes
Yes
No
Planned
6
Yes
Yes
Yes
for defined
groups (LTAC)
No
7
Yes
Yes
Yes
Yes
for ICU
1:100 acute
1:150 w LTC
1:175
1:130 operating
beds or 1:150 total
1:100
Metrics: Hand Hygiene Compliance
Hospital
Metrics
Hand Hygiene Compliance
July-Sept 09
Sept-Dec 09
1
83%
79%
2
89%
89-96%
3
84%
4
Jan-Mar 10
April-Jun 10
76%
71% (implementing
new initiative)
98% (Apr/May)
89%
92%
Transitioning to
different
methodology
92%
89%
April 85%
May 87%
June 91%
87%
5
93.5%
94.3%
93.1%
94.6%
6
86%
89%
90%
May: 90%
June: 91%
April 49 %
May 58%
June 64%
7
In Progress
February 78%
March 60%
Influenza Practices & Metrics
Hospital
1
Influenza
Mask policy
Seasonal flu
vaccination rate
in HCW
CDC
70% overall
(90% in HCW for high
risk pts)
2
CDC
47%
3
SHEA/ WHO
75%
4
CDC
85%
5
SHEA / WHO
76%
6
CDC
34%
7
CDC
85%
Practices: Antibiotic Stewardship
Antibiotic Stewardship
Hospital
Anti-infective Mgt Team
Antibiotic use data available?
1
No longer funded
Not readily, but yes
2
Yes
Yes
3
Not really
Not readily, but yes
4
Yes
Not readily
5
Yes
Not readily
6
In-progress
1st meeting in April
Work in progress
7
No
Yes
Collaborative Process
5) Collaborative process involving structured
activities.
• Face to face meetings
– Texas ID Society, IDSA, SHEA
• Webinars
~ 5 - 6 times/year
• Email distribution list
• Contact information
PDSA Cycle
(Source: Quality Improvement Tools & Techniques)
This template designed to help instruct, construct and present an improvement project
 Set goals based
PLAN
on customer
needs
ACT
STUDY
PLAN
DO
DO
 Implement

Analyze
what
STUDY
happened
ACT
 Make sure
improvement is
permanent
Joint Commission RFI
South Texas Veterans
Health Care System
All
Units
FY
08
HAND
HYGIENE
100%
80%
60%
40%
20%
0%
64%
1st
Quarter
FY08
69%
2nd
Quarter
FY08
Target = > 90% !!
67%
3rd
Quarter
FY08
4th
Quarter
FY08
Cumulative
Training for Staff

Refer your staff for training as needed

The Wash room
– March 18 and 19
– 1 hour workshop
– All 3 shifts
Update
South Texas Veterans Health Care System
Hand Hygiene Compliance
Acute Care Trends 1st Q FY09
ED
Cu
mu
lat
iv e
K5
M
SC
IC
T
BM
SI
CU
CC
U
6B
IC
U
total # of observations/opportunities
687/704=98% compliance
Who?
100% 98%
72% 78%
67%
M
PC
U
5
5A
80% 70%
4S
100%
80%
60%
40%
20%
0%
96% 100%
90% 92%
Timeline
 April 17 – CDC confirmed 1st novel H1N1
virus in California
 April 23 – Cases confirmed in Texas
 April 24 – Confirmation of flu-like illness
in Mexico reported
 Late April - Schertz-Cibolo Universal City
schools closed
SCREENING STATION
BETWEEN UH AND VA
Station #1: Completion of Quick Flu Screening Cards
MRSA Reduction
at Parkland Memorial Hospital
Pranavi Sreeramoju, MD, MPH
Assistant Professor, Medicine – Infectious Diseases
UT Southwestern Medical Center
Chief of Infection Prevention
Parkland Health and Hospital System
UT IC Collaborative Webinar
June 2, 2010
Where we are now
10.00
Rate of CA-BSI in ASC
Units
8.00
Median ASC
6.00
UCL ASC
4.00
Rate of CA-BSI in nonASC Units
2.00
Median non-ASC
Apr-10
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
Feb-09
Jan-09
Dec-08
Nov-08
Oct-08
FY08 Q4
FY08 Q3
UCL non-ASC
FY08 Q2
0.00
MH-TMC
Measuring Compliance with
Isolation Processes
December 1, 2009
Virgie Fisher, CIC
Luis Ostrosky, MD
Measuring the Process
Date
Isolation type Pt. ed.
# Correct correct in
Sheet off
# In Isolation
Sign
Care4
cart
Isolation
Written label on
order on front of
chart
chart
Apr - 08 - Adult
Total audits
% Compl.
118
104
88.1%
98
83.1%
35
29.7%
83
70.3%
60
50.9%
May - 08 - Adult
Total audits
% Compl.
68
57
84
60
88.2
38
56
59
87
45
66.2
Jun-08 - Adult
Total audits
% Compl.
66
63
95.4
61
92.4
30
45.4
58
87.8
45
68.1
80
94.1
43
50.5
38
44.7
68
80
76
89.4
Jul-08- Adult/Children
Total audits
85
% Compl.
Luis Ostrosky, MD
Virgie Fisher, CIC
Infection control and hospital epidemiology
6
5
4
3
Total
2
1
0


Education, supervision, and cohorting
New trend of MDRA cases in rooms previously
occupied by MDRA patients
◦ Cleaning issues!




Re-training
Checklists
Room closures and culturing- Enriched culture media
2x terminal clean + “A Team”, validation
8
60
2X trial
starts
Rooms blocked/cultured after cleaning
7
%
50
6
40
5
4
30
Negatives
Positives
3
20
2
10
1
0
0
JUL 13-19
JUL 20-26
Week
JUL 27-AUG2
% POSITIVE
•
•
•
•
•
Specified topic - Control of MDROs
Clinical and QI experts provide ideas and support,
sharing knowledge and best practice,
A critical mass of multiprofessional teams from multiple
sites willing to improve and share,
Setting clear and measurable targets, collecting data,
and testing changes on a small scale to learn by doing,
Collaborative process involving structured activities.
Monitoring and best practices for:
•
Catheter-related bloodstream infections
•
Surgical site infections
•
Hand hygiene
•
HCW influenza vaccination rate
•
Other