Lancaster General Hospital
Lancaster, PA
463 staffed beds
STEEEP
Effective - By using the luminometer, environmental services is able to ensure a patient space is truly clean.
Patient Centered - By isolating all C. diff. cases, even the potential ones, other patients are protected from this hospital-acquired infection at Lancaster General.
Safe - By decreasing the amount of antibiotics used on patients there is less likely a chance of antibiotic-resistant C. diff. taking hold.
PPE
Create a High Reliability Culture - With a strict policy in place, staff was held responsible for reducing infection rates.
Perfect the Patient Experience - The patient experience was vastly improved with the recuciont of C. diff infections.
Team Members
Lisa Brosey
Senior Director of Quality
Scott Garrety
Director of Environmental Services
Adherence Reduces C.diff
The Problem
In May 2008, Lancaster General had a C. diff rate that was significantly lower than the region or state. Yet that wasn't good enough for the leadership team. The 1.2 per 1000 patient discharge rate needed to be maintained and perhaps get even lower.
The Solution
The secret to Lancaster's success has been their strict adherence to isolation precautions for suspected or diagnosed cases of C. diff. There are no exceptions to their policy. These patients are given private rooms. Even if the bed capacity is at a very low level, patients with suspected or diagnosed C. diff. are not mixed in with the regular patient population. Contact isolation is the norm. An electronic alert regarding newly admitted patients that have had or have been suspected of having C. diff. in the past is sent to both the infection control team and the nursing unit.
Environmental services is an important partner in Lancaster General's C. diff. success. They use a quaternary disinfectant cleaner in patient areas on a daily basis and not just during discharge cleaning. They use a phenolic to clean their emergency department, operating room, and lab areas. They also use a microfiber material to clean surfaces. IT also assists environmental services. Bed tracking technology helps to identify needed isolation cleans.
Additionally, Lancaster is one of a handful of hospitals to use a luminometer system to do quality checks of the areas cleaned. A luminometer measures for adenosine triphosphate, a material which occurs in all mold, bacteria, animal, and plant cells. The measurement from the luminometer verifies whether a space is truly clean or not and is more reliable than visual inspection.
Lancaster General also has a very active infectious disease and infection control department that performs surveillance rounds periodically throughout the week. They are in constant conversation with the nursing team and physicians regarding isolation cases. The physicians are encouraged to look closely at antibiotic use for each patient to ensure that antibiotics are not being overused.
The Results
Lancaster General stayed well below the baseline for their region and the state of Pennsylvania. They also lowered their already low rate. The May 2008 rate of 1.2 infections per 1000 decreased to a rate of 0.6 infections per 1000 by May 2009.
