| Principal Investigator: | Kimberly K. Gonzalez, RN, MSN |
| Organization: | University Health System |
Abstract
Problem
Active surveillance to prevent transmission of Vancomycin Resistant Enterococcus (VRE) was not being implemented consistently on the Transplant Intensive Care Unit (TICU). Data gathered manually may provide opportunities for human error.
Evidence
Evidence was gathered through literature review and appraised based on magnitude of input and feasibility. Best practices chosen for implementation were improving education, improving accuracy of data by automating surveillance, and feedback of data to staff.
Strategy
An electronic database was developed to import data from microbiology records and generate surveillance reports automatically. Education regarding transmission of VRE, active surveillance, and isolation precautions was done through a ten minute in-service with nursing staff individually, along with pre-test. Data were shared with TICU staff monthly.
Practice Change
The changes included implementation of admission screening for VRE, shifting surveillance screening day to reflect census on unit. Data collection changed from manual to automated method. Feedback to the staff through data was done monthly.
Evaluations
Evaluation of the program was done through measuring compliance with screening cultures at admission and weekly, as well as monthly prevalence and acquisition rate of VRE.
Results
Compliance with admission screening improved from 0 to 45%, and weekly screening from 35% to 85% over a 12-month period. Monthly prevalence of VRE decreased from 44% to 7%, whereas acquisition rate improved from 8 per 100 risk-days to 1 per 100 risk-days over the 12-month period. Improvements were also noticed in compliance with hand hygiene and environmental hygiene.
Recommendations
We recommend use of automated databases for surveillance of nosocomial pathogens, continued efforts to control VRE, and monitoring of incidence and acquisition. Multidisciplinary education and multiple strategies are key for success. This model could serve as a process improvement model for other areas in Infection Control.
Bibliography
- Curry, V., & Cole, M. (2001). Applying social and behavioral theory as a template in containing and confining VRE. Critical Care Nursing Quarterly, 24(2), 13–19.
- DeLisle, S., & Ped, T. (2003). Vancomycin-resistant enterococci* a road map on how to prevent the emergence and transmission of antimicrobial resistance. Conundrums in Management of Critically Ill Patients, 123, 504S–518S.
- Hayden, M., Bonten, M., Blom, D., Lyle, E., Vijver, D., & Weomsteom. R. (2006). Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clinical Infectious Diseases, 42, 1552–60.
- Larson, E., Early, E., Cloonan, P., Sugrue, S., & Parides, M. (2000). An organizational climate intervention associated with increased handwashing and decreased nososcomial infections. Behavioral Medicine, 26(1), 14–22.
- Mitchell, A., Cummins, T., Spearings, N., Adams, J., & Gilroy, L. (2002). Nurses’ experience with vancomycin-resistant enterococci (VRE). Journal of Clinical Nursing, 11, 126–33.
- Muto, C., Jernigan, J., Ostrowsky, B., Richet, H., Jarvis, W., Boyce, J., & Farr, B. (2003). SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of staphylococcus aureus and enterococcus. Infection Control and Hospital Epidemiology, 24(5), 362–386.
- Perencevich, E., Fisman, D., Lipsitch, M., Harris, A., Morris, G., & Smith. (2004). Projected benefits of active surveillance for vancomycin-resistant enterococci in internsive care units. Clinical Infectious Diseases, 38, 1108–1115.
- Siegel, J., Rhinehart, E., Jackson, M., & Chiarello, L. (2006). Management of multidrug-resistant organisms in healthcare settings, 2006. CDC.
- Wisniewski, M., Kieszkowski, P., Zagors, T., Sommers, M., & Weinstein, R. (2003), Development of a clinical data warehouse for hospital infections. The Journal of the American Medical Informatics Association, 10(5), 454–462.
- Zirakzadeh, A., & Patel, R. (2006). Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clinic Proceedings, 81(4), 529–536.