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Turning the corners across the border in eliminating C- difficle. The Toronto Western Hospital General Internal Medicine Story. Objectives. To share the general internal medicine and UHN C-diff story To discuss the multiple strategies for staff engagement - PowerPoint PPT Presentation
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Turning the corners across the border in Turning the corners across the border in eliminating C-difficleeliminating C-difficle
The Toronto Western HospitalGeneral Internal Medicine Story
ObjectivesObjectives
• To share the general internal medicine and UHN C-diff story
• To discuss the multiple strategies for staff engagement
• To share our staffs innovations and changes• Share the data
Who we are & How it all beganWho we are & How it all began
• One of Canada’s largest academic hospitals• General Internal Medicine Program• 2006- multiple outbreaks with high mortality rates, increased length of stay and recurrent unit closures• Poor staff satisfaction, poor care reputation
Something had to be done…Something had to be done…
• Traditional education• One on one meetings with the manager• Mandated e-learning modules• Incident reports of breeches• Staff meetings • Daily reminders• Disciplinary action
There was NO change in outcomes… Time to take a different approach
Ask those involved and they have the answerAsk those involved and they have the answer
• It’s a team approach • Its about open listening, and trying the unexpected
Its about taking chancesIts about taking chances
• Loose stool Log • No sinks- install sanitizer everywhere
Loose Stool Log Book
Date Patient Name Stool Sent IPAC
Notified Charge Nurse
Notified Isolation
Precautions
And the answers will comeAnd the answers will come
• House keeping standards
• Remodeled clean and dirty utility room
• Patient specific equipment
• Patient Education
Our IPAC CommitmentOur IPAC Commitment
Our IPAC Commitment
We believe that everyone has a right to a safe environment that is free of hospital acquired infections.
We hold all disciples accountable for being knowledgeable
and maintaining Infection Prevention and Control standards.
To practice Hand Hygiene before and after every patient contact.
To follow Standard Isolation and Routine Precautions.
All equipment will be cleaned before and after use.
To support patients and families in creating a safe
environment.
We promise to support each other in this commitment.
LEARN MODEL ACT
Maintaining our commitmentsMaintaining our commitments
Today…• Commitment to
transparency• Debriefing on nosocomial
infections• Rewards (Individual pens,
30 day noso-free lunches)• Commitment to have open
discussions• Commitment to hold all
staff to the same standard
SuccessSuccessNosocomial (acquired on the floor) CDAD rate, 8ANosocomial (acquired on the floor) CDAD rate, 8A
compared to TWH overall and UHNcompared to TWH overall and UHN
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
Apr-Jun06
Jul-Sep06
Oct-Dec06
Jan-Mar07
Apr-Jun07
Jul-Sep07
Oct-Dec07
Jan-Mar08
Apr-Jun08
Jul-Sep08
Oct-Dec08
Jan-Mar09
Apr-Jun09
Jul-Sep09
Oct-Dec09
Jan-Mar10
Rat
e pe
r 1,0
00 p
t day
s
8A TWH UHN
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
Apr-Jun06
Jul-Sep06
Oct-Dec06
Jan-Mar07
Apr-Jun07
Jul-Sep07
Oct-Dec07
Jan-Mar08
Apr-Jun08
Jul-Sep08
Oct-Dec08
Jan-Mar09
Apr-Jun09
Jul-Sep09
Oct-Dec09
Jan-Mar10
Rate
per
1,0
00 p
t day
s
8A TWH UHN
CDAD
Nosocomial (acquired on the floor) MRSA rate, 8ANosocomial (acquired on the floor) MRSA rate, 8Acompared to TWH overall and UHNcompared to TWH overall and UHN
0.00
0.50
1.00
1.50
2.00
2.50
3.00
Apr-Jun06
Jul-Sep06
Oct-Dec06
Jan-Mar07
Apr-Jun07
Jul-Sep07
Oct-Dec07
Jan-Mar08
Apr-Jun08
Jul-Sep08
Oct-Dec08
Jan-Mar09
Apr-Jun09
Jul-Sep09
Oct-Dec09
Jan-Mar10
Rate
per
1,0
00 p
t day
s
8A TWH UHN
0.00
0.50
1.00
1.50
2.00
2.50
3.00
Apr-Jun06
Jul-Sep06
Oct-Dec06
Jan-Mar07
Apr-Jun07
Jul-Sep07
Oct-Dec07
Jan-Mar08
Apr-Jun08
Jul-Sep08
Oct-Dec08
Jan-Mar09
Apr-Jun09
Jul-Sep09
Oct-Dec09
Jan-Mar10
Rate
per
1,0
00 p
t day
s
8A TWH UHN
MRSA
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Apr-Jun06
Jul-Sep06
Oct-Dec06
Jan-Mar07
Apr-Jun07
Jul-Sep07
Oct-Dec07
Jan-Mar08
Apr-Jun08
Jul-Sep08
Oct-Dec08
Jan-Mar09
Apr-Jun09
Jul-Sep09
Oct-Dec09
Jan-Mar10
Rate
per
1,0
00 p
t day
s
8A TWH UHN
Nosocomial (acquired on the floor) VRE rate, 8A compared to TWH overall and UHN
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
Apr-Jun06
Jul-Sep06
Oct-Dec06
Jan-Mar07
Apr-Jun07
Jul-Sep07
Oct-Dec07
Jan-Mar08
Apr-Jun08
Jul-Sep08
Oct-Dec08
Jan-Mar09
Apr-Jun09
Jul-Sep09
Oct-Dec09
Jan-Mar10
Rate
per
1,0
00 p
t day
s
8A TWH UHN
VRE
ObjectivesObjectives
• To share the general internal medicine and UHN C-diff story
• To discuss the multiple strategies for staff engagement
• To share our staffs innovations and changes• Share the data
