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

tracey.fletcher@uhn.on.ca

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