Trillium Health Centre is one of the first hospitals in the GTA to successfully implement the new Health Canada guidelines on preventing transmission of infections (Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care – Revision of Isolation and Precaution Techniques (1999) ). The new guidelines, in place at Trillium since 2000, mean patients with potentially infectious diseases and infectious diseases do not always need to be confined to their rooms, visitors don’t need to wear gowns and gloves, and patient rehabilitation can be continued without interruption. Staff have more flexibility to make decisions and the guidelines are clearer allowing for quicker, more effective clinical decisions.
Under the previous guidelines, patients with an infectious disease were often kept in ‘isolation’ in single rooms. Today, most patients can room safely with another appropriately chosen roommate when health care providers take precautions. Typically these days, only patients receiving airborne precautions are treated in single, negative pressure rooms. The former guidelines were disease-based and therefore a challenge to implement because clinical staff required a thorough understanding of most diseases. They were also quite restrictive, but with today’s improved knowledge of disease transmission and advanced technology, Health Canada was able to make more flexible recommendations. This new flexibility is reflected in the guidelines terminology. Patients appreciate the new friendlier wording of ‘additional precautions’ as it is less intimidating than the old ‘isolation’ term.
Following the recommendations in the guidelines, Trillium introduced a new set of protocols and tools that are easier for patients and staff to follow. The tools provide quick reference information so front line nursing staff are now able to determine the level of care a patient needs quickly. The reduced need to always wear the barrier devices such as gowns, gloves, and masks saves on time, supplies and frustration while still maintaining safe practice for patients, staff and visitors. Bed utilization has also benefited from having fewer restrictions on the placement of patients across the facility.
A team of managers, front-line nurses and infection control practitioners developed Trillium’s protocols. The infection control practitioners then developed several user-friendly tools such as a contact cart, a Rapid Ready Reference flip chart, and signs for front-line staff to use when a patient requires additional precautions. Based on the three main transmission categories – airborne, contact, and droplet, the tools offer an easy referral resource and have proven to be a huge time saver.
Contact CartProviding one-stop shopping, the cart contains all the required supplies and equipment for preventing the potential transmission of organisms by the contact route. Besides the huge time saving and decreased frustration it provides to nursing staff and infection control practitioners, the cart also saves time in many non-clinical departments including stores, central supply, and linen.
Rapid Ready Reference (RRR) FlipchartA quick and easy tool, the colour-coded RRR provides staff with information on how to handle most of the common infections as well as which precautions are necessary.
SignageWhereas the RRR is a quick reference tool for staff, the signs provide guidelines for patients and visitors to follow. The colour-coded signs are located right outside the patient rooms and contain pictorial information such as whether gowns and masks are required or if the door to the patient’s room should remain open or closed. This has been very beneficial to our many families with English as a second language.
Following the development of the protocols and tools, the Infection Control Practitioners moved into the second phase of their project – educating staff on the new guidelines. Hospital wide education was an important requirement prior to implementation. A full day session was held for clinical leaders and ongoing drop-in sessions were organized for all staff. Unit based in-services were also provided. Today new staff and volunteers are introduced to the new Routine and Additional Precautions guidelines during their orientation and continuous education is always available for staff needing a refresher.
It has been two years since the new guidelines were put in place and things are running smoothly. Trillium’s infection prevention and control staff are continuously monitoring the Health Centre’s additional precautions program. Based on the outcomes of admission screening, audits and other monitoring techniques, the infection control practitioners are confident the new guidelines are being successfully implemented as Trillium’s nosocomial (hospital acquired) transmissions rates have significantly decreased.