A Success Story

1
A Success Story

• Presented by
• Janice McIntyre, RN, IPACP
• Huron Perth Healthcare Alliance

2
Huron Perth Healthcare Alliance

• 200 bed Alliance
• Four Sites
• Stratford
• St. Marys
• Seaforth
• Clinton

3
Increased Incidence

• Increased number of patients colonized
• Stratford Site with MRSA
• St. Marys site with VRE

4
ARO Management Team

• Called a meeting to discuss and implement
  strategies

5
ARO Management Team

• Consisted of the following
• Chair of Infection Control Committee(Pathologist)
• IPACP
• Charge Technician, Microbiology
• Program Directors for
• Housekeeping, Dietary, Nursing Units
• Clinical Resource Nurses
• Nurse Educators
• Public Health MOH Infection Control Liaison

6
ARO Management Team

• This team met
• daily for the first week
• bi-weekly for two weeks
• weekly for six weeks

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Goal

• To contain and prevent further spread of MRSA and
  VRE at the Stratford and St. Marys sites.

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Measures Implemented

• All affected patients
• were isolated and co-horted
• Enhanced isolation precautions put in place

9
Measures Implemented

• Education of staff
• Implemented visitor restrictions
• Only two visitors per patients
• Visit only one patient in hospital
• Volunteers encouraged handwashing
• Educational brochures

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Measures Implemented

• Education of public
• Initiated press release
• Foundation Director and Chair of the Infection
  Control Committee handled the press.
• The Chair of Infection Control Committee met with
  physicians.

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Measures Implemented

• Used disposable dishes and food trays
• Not for infection control purpose
• Additional cleaning of high touch areas
• Modified workers

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Measures Implemented

• Increased screening
• All admissions were screened nasally and
  rectally.
• All in-patients who had not been screened both
  nasally and rectally upon admission were
  screened.
• Prevalence screening weekly of affected areas.

13
Measures Implemented

• Clarity leads to increased compliance
• All communication through Infection Control
  Department
• Signage for staff and visitors
• Documentation

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Greatest Challenges

• Involved two different sites
• Ensuring ALL staff and physicians followed all
  the precautions
• The nurses became the enforcers
• Protecting non-colonized patients on affected
  units.

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Greatest Challenges

• Complex Continuing Care Unit
• Transfers from Medical Floor
• Large bio burden
• Decreasing staff morale
• Understaffed
• Heavy workload

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Greatest Challenges

• Physiotherapy department
• Should the ARO patients should not go to physio?
• Resistance from the physiotherapy staff

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Greatest Challenges

• Walk through Physiotherapy Department
• Strategies put in place
• Non-colonized patients treated first, then
  colonized patients followed by a cleaning.
• Common stairs cleaned between patients

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Greatest Challenges

• To Decolonize or Not to Decolonize
• The committee struggled with this issue, some
  wanted to decolonize to get this over with.
• The Infection Control Committee decided not to
  decolonize.

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Greatest Challenges

• Long Term Care Facilities
• Reluctant to take back their patients
• Public Health Unit
• Developed a fact sheet
• Fielded questions

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Lessons Learned

• Dont Panic!!!
• Keep the lines of communication open
• Involve all staff
• Visit units
• Universal screening of all patients with the
  exception of psychiatry and maternal child units.

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Moving forward

• Maintaining a contact patient list
• Maintaining good continuous line listings
• Computer generated isolation report
• Following up with 6 months of prevalence
  screening
• Enhanced active surveillance

22

• Questions