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Establishment of IPC resource staff role in the Emergency Department in response to a global pandemic
Presenter: Mike OÇallaghan, Canterbury DHB
Authors: Mike O’Callaghan, J. Gerken,C. Beasley L. Robertson
As part of preparedness and response activities, EDs around the world reviewed their protocols to deal with COVID-19 and strong links to Infection Prevention and Control services (IPC), infectious diseases departments and public health were needed. Therefore, as part of local ED preparedness activities, a project was implemented to establish IPC resource nurses. This included: a conceptual framework, as well as design, delivery and evaluation of initial training.
Evaluation was carried out at three months to systematically appraise learning outcomes according to level one of Kirkpatrick’s outcomes typology. Data was collected using a purpose designed paper-based course evaluation form with eight items (and a five-point Likert rating scale).
Fourteen participants were trained. Five participants returned completed evaluation forms (response rate = 36%). Participants experienced knowledge gains from this seminar. 80% (n=4) strongly agreed training prepared them for their role as IPC resource for ED. 100% (n=5) of participants strongly agreed they saw value in the IPC resource role. One key area of performance was acting as a PPE champion. 80% (n=4) agreed that they sought opportunities to do this. 40%(n=2) of respondents agreed they were able to help their colleagues understand special IPC risks in the ED setting, and 60% (n=3) were neutral on this point. Another key area of performance was special projects, e.g. PPE stations and negative pressure rooms. Given these projects were being undertaken while a continuing COVID-19 response was underway (and a physical relocation of department took place), some delay to project progress was reported.
While there were limitations related to the COVID-19 pandemic response and the migration of the department, the overarching goal was successfully achieved. Planning is underway to replicate this concept in ICU.
Mike is a registered nurse who trained in the UK. He has over 30 years’ experience in emergency nursing including senior management roles. He came to live in New Zealand in 2006 and for the past seven years has been a CNS in the CDHB Infection Prevention Service and like everyone in this field has been a little busy during the last 18 months!
He is a HUGE Dr Who fan and enjoys long beach walks with Casper the dog.
Implementation of a new IPC intervention bundle for environment management for patients identified with Clostridium difficile infection
Sacha McMillan, Canterbury DHB
Background: Clostridium difficile is a prevalent healthcare-associated infection. Clostridium difficile infection (CDI) is associated with increased length of hospital stay, costs, morbidity and mortality in adult and paediatric patients. The hospital environment is one of the key pathways for patients to acquire CDI and contaminated environmental surfaces are one of the most important sources of Clostridium difficile infection transmission in clinical areas. Locally, a problem was identified that Environmental Services were not being notified on the acquisition date of cases of CDI. Without this critical information, it meant that regular cleaning products were used for daily room cleans rather than sodium hypochlorite (the recommended product to ensure effective decontamination against highly resistant Clostridium difficile bacterial spores).
Methods: A collaborative project between the Infection Prevention and Control (IPC) Service and Environmental Services focused on introducing a new IPC intervention bundle optimising product use, cleaning technique, staff training, communication and audit to ensure best practice management of the environment for patients identified with Clostridium difficile infection during an inpatient hospitalisation. Tailored training activities and educational content for key stakeholders were part of the new IPC intervention bundle.
Evaluation: Details of CDI incidence were more effectively documented and timely communication of CDI occurred to both environmental services staff and clinical ward staff. Although no healthcare-associated infection transmission cases or outbreaks occurred, the incidence of cases captured in the monthly reports increased. This was attributed to closer monitoring and documentation rather than actual increase in incidence rates. Results through stakeholder feedback showed improved environment management for patients identified with CDI during an inpatient hospitalisation.
Conclusion: The introduction of a new IPC intervention bundle achieved sustained practice improvement changes in environment management for patients identified with CDI during an inpatient hospitalisation.
Sacha McMillan is a Clinical Nurse Specialist in the CDHB Infection Prevention and Control Service. Sacha enjoys working with staff to improve their understanding of all things IPC. Weekend hobbies include horseback riding and she is an active member of the IPC synchronised swimming team.
Creating a safe harbour: rapid establishment of a cohort isolation ward for patients with dementia suffering from COVID-19
Julianne Munro, Christchurch DHB
Older adults are particularly vulnerable to outbreaks and cognitive impairment may also increase risk of infection transmission meaning persons with dementia are at heightened risk of COVID-19. In April 2020, in national lockdown, Burwood Hospital IPC Specialists received instructions to establish a cohort isolation ward. This was a significant IPC challenge with levels of uncertainty and complexity not previously encountered.
Staff safety was paramount in a high-risk setting with emphasis placed on safe donning and doffing practices. A buddy system was implemented. Because of the nature of the residents, it was not possible to confine them to room isolation, staff were therefore required to wear enhanced PPE for their entire shift. Red and Green zones were established to enable staff to have critical 2 hourly breaks and rest periods during the 12-hour shifts. Management of food services, linen, laundry and healthcare waste needed to be adapted to the high level of risk.
An empty surgical ward was home for residents (of which 5 were COVID-19 positive and 7 others symptomatic) for five weeks. Provision of quality PPE became problematic at times, with vast amounts used. A variety of gowns, goggles, faceshields, surgical and N95 masks were need as PPE was pushed to its limits. Staff experienced pressure injuries from goggles and N95 masks worn for long periods of time. Four resident-to-staff transmission events occurred with breaches of PPE identified in all cases, some were contributed to by residents who would pull, rip PPE or touch staff faces during interactions.
Continuous process refinement and IPC Specialists available on-the-spot to trouble-shoot provided the safety net needed in a high-risk setting. Despite significant challenges, the experience of collaborating to shelter a vulnerable group of people strengthened our sense of connection to our colleagues and pride in our role.
Over 20 years working in Infection Prevention has afforded me with a wide range of experience in a variety of services. These have included community, private services, older persons health and aged care facilities as well as Ministry of Health guideline and education input. More recently I have been based at Christchurch Hospital campus covering Women and Child’s Health for Canterbury District Health Board. This service includes maternity, gynaecology, paediatrics, Children’s Oncology Unit and neonatal services with a neonatal intensive care unit.
Preventing cross infection of multidrug resistant organisms whilst using a risk -based approach in healthcare settings has been a passion of mine. I have also had significant experience in outbreak management of an assortment of microorganisms.
How WDHB revolutionised their IV auditing process
Presenter: Sandi Gamon, Waitemata DHB
During 2020 Waitemata DHB trialled a cloud based electronic auditing software to improve reporting and closure of the quality improvement loop. Initially this tool was only used to improve the environmental audit process – however it quickly became apparent that it had uses beyond just this subject. I late 2020 the vascular access group approached IPC as their annual hospital wide audit was approaching and they wanted to use the tool to conduct the audit. The Director of Nursing & Midwifery was very supportive of the idea. On the day of the audit there were NSH 23 wards audited (Including ESC) & WTH 7 wards. All charge nurses were sent an email by 2000 the same day with a report of their results. Overall, the results highlighted issues with documentation rather than IV line management. As a result the DHB has partnered with ACC to implement their know your lines programme.
Pseudomonas aeruginosa in NICU: A slow motion crisis
Presenter: Henrietta Sushames
In 2020 staff declared a pseudomonas outbreak in the neonatal intensive care unit, CCDHB. The risk factors had been present for many years but never addressed. The cases presented over a month. We identified the source but not the mode of transmission. The analysis took time, and in the meantime a variety of mitigation strategies were put in place. Some proved effective and others were later abandoned. Keeping risk assessment as IPC core business could have prevented the tragic infant outcome.
Henrietta has worked as a clinical nurse specialist in Infection, Prevention and Control at Capital and Coast DHB for three years and is secretary of the IPCNC committee. Before this she enjoyed a long career in child health nursing. She is passionate about hand hygiene. In her spare time she gardens, cooks and hustles her boys to clean the house.