SMDC Health System

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MRSA PREVENTION STRATEGIES
SMDC Health System Duluth, MN
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Administrative Support

• Hospital Clinic Operation Leadership
• Education
• MD Buy-In
• Financial/IS resources
• EPIC resources
• Rapid Testing
• Support for ASC
• Isolation Equipment/ Supplies

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SMDC MDRO Task Force

• All SMDC hospitals
• Multi-disciplinary
• IPC / ID
• Inpatient /ED/Rehab Nursing
• PT/OT
• Environmental Services
• Patient Transportation
• Ad hoc members

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Key Issues

• Identification of patients with MRSA history
• Room placement / Contact Precautions
• Out of Room activities
• Communications
• Interdepartmental
• Patient Care areas
• D/C of MRSA precautions/ markers
• Staff Education
• Patient Education / communications
• Environmental / equipment disinfection
• Compliance Hand Hygiene/Contact Precautions
• Future Screening protocols (ASC)

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focus on processes
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Identification of patients with MRSA History

• Previous
• Flags in all electronic MRs
• (SMMC, SMHS, MDMC)
• Lab generated messages
• Enhancements
• HBOC flags/ Bed tracking interface (SMMC) July
  07
• EPIC Problem list September 07

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EPIC Problem List
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Room Placement Patient Isolation Protocol
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Revised Contact Precautions Out of room
Activities
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Communications
Inter- departmental (Hand-Off Communications)
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Communications
Medical/ Nrsg Staff
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D/C of MRSA Precautions

• MRSA ( VRE) patients removed from precautions/
  problem list by IPC department ONLY

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Staff Education Training

• General Orientation
• New employees
• Annual Safety/Accident Prevention
• Nursing Skills Day
• Eat Educate Sessions
• Informal tool talks on nursing units
• Ancillary department meetings
• IPC Newsletter-Isolation Edition/FAQs
• Patient Care Management Committee
• Intranet portals

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Other

• Hand Hygiene
• Observations/ Monthly reports
• Patient Satisfaction Surveys
• Review of HH products
• Process Review/Revisions
• Pre-Admission/Procedure Assessment
• Perioperative process/communications
• Patient Transport
• Single-Patient Use items
• Value Analysis Committees

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Other

• Environmental Disinfection
• High-touch surfaces
• Checklists
• Glow-germ monitoring
• Equipment Disinfection
• Review of ownership
• Patient / Visitor Communications
• Patient education materials
• Letter to patients
• Antimicrobial Stewardship
• Antibiotic Review Committee
• Antibiotic Support Team
• On-line /Posted Antibiograms

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How are we doing
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going forward
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Active Surveillance Screening

• Fall 2008
• Screen high-risk admissions all inpatient units
• LTC
• Dialysis
• Transfers from other hospitals
• Etc
• Isolate at time of discovery
• Rapid Testing Technology???
• Clinic-based screening opportunities
• Contact Precaution compliance monitoring
• 2009-2010
• Expand to high-risk surgery patients
• Antibiotic utilization in ambulatory sites

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Challenges

• Patient Satisfaction Issues
• Physician Buy-In
• CMS/ other reimbursement
• Staffing issues
• Nursing/patient ratios
• Environmental Services
• Multiple organizational initiatives
• Other Patient Safety Goals
• CMS Core Measures