36x72%20poster%20template

1

STANDARDIZATION OF ISOLATION PRACTICES IN THE
PERIOPERATIVE CARE SETTING Lorrie Ingram, BSN,
RN, Infection Control Practitioner Susie
(Treasa) Leming-Lee, MSN, RN, CPHQ, Director of
Perioperative Quality Management Vicki Brinsko,
BSN, RN, CIC, Infection Control Practitioner,
Dept. Coordinator Jena Skinner, BSN, RN, CIC,
Infection Control Practitioner Ann H. Benco,
MSTD, BSN, RN, CNOR, Perioperative Nurse
Educator Erin Kuhn, RN, MSN, CNOR, Perioperative
Nurse Educator Audrey H. Kuntz, EdD, RN,
Director of Perioperative Education/Operative
Services Stephanie Randa, MHA, RN, Director of
Operative Services Thomas R. Talbot, III, MD,
MPH, Hospital Epidemiologist, Infectious Disease,
Titus L. Daniels, MD, MPH, Assistant Professor
of Medicine-Infectious Disease, Associate
Hospital Epidemiologist Addison K. May, MD,
FACS, FCCM, Associate Professor of Surgery and
Anesthesiology
ABSTRACT
RESULTS
IMPLEMENTATION DESIGN FLOW OF WORK PROCESS

• The management of operating room (OR)
  traffic, environmental cleaning, patient
  transport, supplies and appropriate signage were
  other key elements of concentration identified
  for practice change. Improved compliance with
  isolation practices was observed soon after
  implementation. While not directly attributable
  to the perioperative isolation enhancements
  (simultaneous interventions were introduced in
  the critical care areas) no further HR-ACBA
  cluster outbreaks were identified (Fig. 3).

2008 APIC Abstract Subject Category - Quality
Management Systems/Process Improvement/Adverse
Outcomes Standardization of Isolation Practices
in the Perioperative Service Line Lorrie Ingram,
BSN, RN, Infection Control Practitioner Vicki
Brinsko, BSN, RN, CIC, Infection Control
Practitioner, Dept. Coordinator Jena Skinner,
BSN, RN, CIC, Infection Control Practitioner
Ann Benco, RN, Nurse Educator, Operative
Services Erin Kuhn, RN, MSN, CNOR, Perioperative
Nurse Educator Audrey H. Kuntz, EdD, RN,
Director of Perioperative Quality Mgmt/Operative
Services Susie Leming-Lee, MSN, RN, CPHQ,
Associate Director of Perioperative Quality
Management/Operative Services, Thomas R. Talbot,
III, MD, MPH, Hospital Epidemiologist, Infectious
Disease, Assistant Professor of Medicine and
Preventive Medicine, Titus L. Daniels, MD, MPH,
Assistant Professor of Medicine-Infectious
Disease, Associate Hospital Epidemiologist ISSUE
A cluster of Highly-resistant Acinetobacter
baumannii (HR-ACBA) cases in the surgical
critical care unit of a large tertiary care
medical center provided the impetus for detailed
scrutiny of isolation practices, particularly for
patients requiring multiple trips to surgery.
Noncompliance with aspects of isolation was
observed for patients during transport between
surgery and critical care. Further investigation
revealed a systems approach to improvement would
be needed, not only to prevent transmission
during transport, but to enhance compliance for
all areas of patient contact throughout the
perioperative service line. PROJECT A
multidisciplinary team was formed with
representatives from surgical critical care,
perioperative education, operating room personnel
and infection control, to review the existing
practices used for handling patients in isolation
and to map out an enhanced process (Figure 1) for
improvement. System barriers to compliance were
identified in all phases of the perioperative
patient care process. System enhancements were
identified and implemented to facilitate
compliance. These included specific education
and training modules developed for all levels of
staff, including physicians. Perioperative
isolation practice standards were formally
incorporated into the departmental policy and
procedure manual. RESULTS A unified set of
isolation practice standards throughout the
perioperative service line was established, which
mirrored the existing isolation guidelines
practiced throughout the rest of the medical
center. System changes included creating
electronic case boarding prompts, (Figure 2) to
actively inquire as to isolation status and type
required, as well as electronic reminders to book
airborne isolation cases at the end of the day.
The management of operating room (OR) traffic,
environmental cleaning, patient transport,
supplies and appropriate signage were other key
elements of concentration identified for practice
change. Improved compliance with isolation
practices was observed soon after implementation.
While not directly attributable to the
perioperative isolation enhancements
(simultaneous interventions were introduced in
the critical care areas) no further HR-ACBA
cluster outbreaks were identified (Figure 3).
LESSONS LEARNED Although most staff understood
the institutions isolation mandates for contact,
droplet and airborne precautions, problems were
identified with communication between departments
on patient isolation status and proper practices
for transporting patients between perioperative
areas and critical care. The concept that the OR
environment, with respect to routine practices of
sterile and aseptic technique, would inherently
prevent cross transmission of organisms from
patients in isolation was deficient as it did not
include appropriate practice patterns prior to
and after surgery. This intervention project
served to increase awareness and education of the
perioperative staff regarding infection
prevention and control practices with their
isolated patient population. Behavioral changes
reflecting improved compliance were influenced by
staff collaboration, use of new electronic case
boarding prompts and creative methods of
communication and education. In addition,
providing a new, concentrated and standardized
process algorithm to guide the units/OR staff in
preparing for and organizing the isolation
patients transport, equipment handling and
environment, was a vital tool for quality
improvement. These concepts are reproducible for
other service areas with similar clinical
challenges.
Fig. 3
Fig. 1
CONCLUSION LESSONS LEARNED
METHODOLOGY/TRAINING

• Although most staff understood the
  institutions isolation mandates for contact,
  droplet and airborne precautions, problems were
  identified with communication between departments
  on patient isolation status and proper practices
  for transporting patients between perioperative
  areas and critical care. The concept that the OR
  environment, with respect to routine practices of
  sterile and aseptic technique, would inherently
  prevent cross transmission of organisms from
  patients in isolation was deficient as it did not
  include appropriate practice patterns prior to
  and after surgery.
• This intervention project served to increase
  awareness and education of the perioperative
  staff regarding infection prevention and control
  practices with their isolated patient population.
  Behavioral changes reflecting improved compliance
  were influenced by staff collaboration, use of
  new electronic case boarding prompts and creative
  methods of communication and education. with
  similar clinical challenges.
• Lessons Learned Include
• Ensure need for support of project by visible
  leadership.
• Provision of a standardized process algorithm to
  guide staff adherence and education was a vital
  component of this quality improvement process.
  These concepts are reproducible for other service
  areas.
• Early Solicitation of staff input in the
  development of this process, as were the specific
  tools, was vital to overall success.
• Education of all perioperative staff and faculty
  was critical to the ownership of the process, and
  for its continued success.

• Key Fundamental Infection Control Concepts
  Applied
• Strict Hand Hygiene adherence
• Strict/Consistent use of PPE for specific
  precautions
• Appropriate Environmental cleaning/disinfection
  processes
• Special indications (i.e. for air
  handling/exchanges for TB)
• Continuous good communication during surgery
  booking process, between the referral/transferri
  ng dept. the Periop Services regarding patients
  isolation status
• Highlights and education pertaining to very
  specific and highly transmittable organisms in
  the healthcare environment reviewed

INTRODUCTION
METHODOLOGY/TRAINING

• A unified set of isolation practice standards
  throughout the perioperative service line was
  established, which mirrored the existing
  isolation guidelines practiced throughout the
  rest of the medical center. System changes
  included creating electronic case boarding
  prompts (Fig. 2) to actively inquire as to
  isolation status and type required, as well as
  electronic reminders to book airborne isolation
  cases at the end of the day. The management of
  operating room (OR) traffic, environmental
  cleaning, patient transport, supplies and
  appropriate signage were other key elements of
  concentration identified for practice change.
  Simultaneous interventions were introduced in the
  critical care areas.
• Key Fundamental Infection Control Concepts
  Applied
• Strict Hand Hygiene adherence
• Strict/Consistent use of PPE for specific
  precautions
• Appropriate Environmental cleaning/disinfection
  processes
• Special indications (i.e. for air
  handling/exchanges for TB)
• Continuous good communication during surgery
  booking process, between the referral/transferri
  ng dept. the Periop Services regarding patients
  isolation status
• Highlights and education pertaining to very
  specific and highly transmittable organisms in
  the healthcare environment reviewed

INTRODUCTION
A multidisciplinary team was formed with
representatives from surgical critical care,
perioperative education, operating room personnel
and infection control to review the existing
practices used for handling patients in isolation
and to map out an enhanced process for
improvement. System barriers to compliance were
identified in all phases of the perioperative
patient care process. System enhancements were
identified and implemented to facilitate
compliance. These included specific education
and training modules developed for all levels of
staff, including physicians. Perioperative
isolation practice standards were formally
incorporated into the departmental policy and
procedure manual.
NEW ISOLATION PRECAUTION PROCESS IN ACTION

Acknowledgements Daniel Beauchamp, MD, Chair of
Surgical Sciences Mike Higgins, MD, MPH,
Executive Medical Director of Perioperative
Services Nancye Feistritzer, MSN, RN Associate
Hospital Administrator, Director of Perioperative
Services Surgical Site Infection Prevention
Collaborative Committee
Fig. 2