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Double-Teaming MRSA and C. diff.
Mary Buchanan, BSN, ARNP-BC, CIC and Ted Newton, RN, BS, BSN, MHA, CIC, CHSP
Dwight David Eisenhower Army Medical Center
Fort Gordon, GA
As leaders in infection prevention at the Dwight David Eisenhower Army Medical Center in Fort Gordon, Georgia, Mary Buchanan, BSN, ARNP-BC, CIC, and Ted Newton, RN, BS, BSN, MHA, CIC, CHSP, have implemented numerous initiatives to cut infection rates.
Using their combined military and civilian experience, Buchanan (now retired) and Newton developed two process system improvements that significantly improved patient safety, despite a high staff turnover rate due to deployments.
The first initiative reduced healthcare-associated Clostridium difficile from a 2007 rate of 8.2 per 10,000 patient bed days to a 2008 rate of 6.6. This was achieved by changing the notification process for patients screened for C. diff toxins and ensuring patients remained on contact precautions until negative test results were received; posting reminder signs in rooms of patients with suspected or confirmed cases; requiring staff to wash their hands at the sink before leaving the patient’s room; and cleaning rooms with 1:10 bleach.
The second undertaking reduced healthcare-associated MRSA from 3.1 cases per 1,000 admissions in 2007 to 1.7 in 2008, and cut VRE from 0.2 cases per 1,000 admissions in 2007 to 0.1 the following year. A hand hygiene campaign raised compliance from 60-70 percent to 90 percent. The infection prevention department conducted research to determine which patients had a history of MRSA or VRE, and had not been cleared under multidrug-resistant organism precautions. They provided this information to unit managers and physicians daily, to ensure these patients were placed on precautions until they were cleared by culture.
A switch to a Chlorhexidine prep product for skin site insertions and in the cardiac catheter lab and OR – along with integration of blood culture technique training into nurse orientation procedures – reduced the blood culture contamination rate from 2.7 percent to 1.6 percent between 2007and 2008. “We had a relatively low rate to begin with,” said Buchanan, “but we wanted to take it down as close to zero as we could get it.”
They also reduced sharp object injuries from 4 per 10,000 bed days in inpatient units to 2; from 2.6 per 1,000 cases in the OR to 1.4; and from 1.4 per 10,000 phlebotomy procedures to 0.3 by replacing an outdated type of needle, implementing a sharps safety instruction block for nurse orientation and increasing communication to all staff.
Newton assumed Buchanan’s position as chief of infection control at Eisenhower after her retirement in August 2009.