Infection control part of hospital culture

A key component of Infection Control protocols at Windsor Regional Hospital occurred in early 2008 when the hospital engaged in a Strategic Planning exercise that involved front line employees, physicians, Board members and the community. A culture of Patient Safety and Quality was established by setting a Vision of Outstanding Care-No Exceptions! One of the strategic directions arising from the strategic planning was to Embed patient quality and safety in the culture of the hospital. This strategic direction was operationalized by July 2008, with among other things, the creation of weekly Directors’ ‘Huddle’.

Each and every Monday morning, Directors “check the pulse” of the hospital by reviewing key quality and safety indicators. This enables communication and ownership; builds culture of safety by focusing on current outcomes; provides timely access to data and promotes accountability for action because each leader is responsible for implementing and monitoring patient safety improvements. Key quality and safety indicators focus on various hospital acquired infections and hand washing rates.

At one point, Windsor Regional Hospital was using Infection Control best practices that included a screening tool upon admission to an inpatient unit, it noticed hospital acquired infections were not declining. This involved completing a risk assessment for MRSA/VRE screening swab followed by a four-day wait for test results and, if confirmed, the patient is moved to isolation.

After reviewing processes and data, and after ongoing discussion and debate at the weekly ‘Huddle’ sessions, it was determined that test ‘waiting days’ might be a factor. Patients, visitors and staff continued to be at-risk for contact transmission during the test/result period. The change occurred when it was agreed to treat the at-risk patient as if they are positive until proven otherwise. Guilty until proven innocent! What came out of the process was the concept of earlier screening and Preventive Cubicle Isolation.

Now, all admitted patients are screened for MRSA/VRE in the Emergency Department. If at-risk, the patient is swabbed immediately and when transferred to a unit, is placed in Preventative Cubicle Isolation that includes bed curtains defining a ‘space’ along with highly visible alert signs placed on the patient room door with contact precautions and special cleaning of touch items in common areas. If a test is negative, Preventative Cubicle Isolation is discontinued.

In the first three months of post-implementation, 120 preventative cubicle isolation patients were confirmed positive. Several professionals made this occur with the network mobilized; Infection Control enhancements easier to place into action such as dealing with H1N1; yellow armband and ID outside of rooms and; fine tuning of the screening tool.

Capitalizing on the weekly ‘Huddles’, Windsor Regional Hospital next engaged its Board of Directors and other leaders directly in Patient/Quality issues. An electronic tool was created allowing users to see updated indicators. Characteristics include a high-level roll-up with a ‘red-green-yellow’ format to indicate where each of the established indicators of quality are.

Dynamic representation of data allows individualized drilldown and dissemination of results for action planning with built-in accountability to facilitate problem-solving for improvement. This has also been extremely helpful for all departments to focus on their budgets toward achieving required savings to balance at year end.

These same key quality and safety indicators are shared with all staff including the public at large by posting on the hospital’s external internet. In 2008, Windsor Regional hospital was one of the first to post traditionally “private” data on its internet site for the public to view, critique and comment. Most recently, Windsor Regional Hospital now publishes on its internet site 26 patient quality and safety indicators, the same indicators that are monitored monthly by the hospital’s Board of Directors.

Performance has improved by reporting data both internally and externally, monitoring quality and taking action. As a result, participation and follow-up are immediately evident. Examples include a 50 per cent improvement in Pathway compliance, more than 90 per cent hand washing compliance and reduced hospital acquired infections. Now, Windsor Regional Hospital focuses on outcomes without confusing ‘what’ the hospital is doing with ‘how’ it is doing, paying attention to the data and not mistaking improvement for achievement.

“Some of the infection control practices that were created by staff at Windsor Regional Hospital have been selected to be showcased as Leading Practices in the upcoming Ontario Hospital Association 2009 International HealthAchieve Conference,” says David Musyj, President and CEO of Windsor Regional Hospital. “We have seen dramatic improvements in patient quality outcomes and safety and it is the staff, who are the engine that drive Windsor Regional Hospital who are to be recognized for these achievements. Through continual monitoring and action along with being fully transparent with our data, we are moving towards achieving our goal of not causing any harm to patients.”

And, on a timely issue, Windsor Regional Hospital was prepared for the release and dissemination of the H1N1 vaccine, immediately vaccinating its staff as a first step to protect the public when requiring health care at the hospital. Communication was intensified related to visiting the hospital, reminding the public to continually wash their hands upon entrance and exit; refrain from visiting the hospital if experiencing respiratory symptoms such as cough, sore throat, runny nose or fever and, seek medical attention and treatment if those symptoms increase.