Rural Infection Control

“Prevention is our Intention”

In November 2002 the Infection Prevention & Control Unit at the Bendigo Health Care Group launched a project during Infection Control Awareness Week, which was titled “Prevention is our Intention” .   The problem to be addressed included poor compliance of staff with hand hygiene, lack of cleaning of non-critical equipment, endemic MRSA rates of 5% or higher and potential for nosocomial VRE from colonised renal dialysis patients.

• Improving acute clinical staff hand hygiene compliance
  
  
• Improving cleaning of frequently used clinical equipment
  
  
• Reduce and sustain MRSA colonisation rates to 3-5% in adult acute clinical units (particularly the critical care unit)
  
  
• Reduce MRSA infection rates

This project is based on Pittet's work (University of Geneva Hospital) and the DeBug Infection Prevention Program (Austin Health).

Methods included:

• Introduction of an alcohol hand rub (DeBug) and strategically place throughout the hospital.
  
  
• Introduction of alcohol wipes to enable staff to conveniently clean non-invasive clinical equipment.
  
  
• Environmental sampling of equipment.
  
  
• Weekly screening of critical care patients for MRSA and active follow up of colonised patients with Mupirocin nasal ointment and Triclosan body wash.
  
  
• Education program for staff providing evidence for project and feedback on screening and surveillance results.
  
  
• Innovative advertising/marketing campaign included poster development encouraging hand hygiene and cleaning of equipment.

The outcomes were so positive that the project was extended across all campuses.   DeBug is now sited across Bendigo Health Care Group, including public areas.

• MRSA rates in the critical care unit have generally improved with rates below 5% (over a three month period), ranging from 3.84 in week 6 of the project, 1.86 in week 9, and 1.93 in week 13.
  
  
• Improved cleaning of non-critical equipment has been observed where alcohol wipes have been strategically placed and bracketed.
  
  
• No nosocomial spread of VRE has occurred.
  
  
• Improvement in staff awareness of the necessity to comply with hand hygiene.
  
  
• No MRSA, VRE or other significant organisms were isolated from environmental sampling in the Critical Care Unit.
  
  
• Observed increase in hand hygiene compliance by medical staff during ward rounds in the critical care unit.
  
  
• Increased usage of DeBug over 6 months and thus an increased compliance with hand hygiene.
  

• Ongoing monitoring of hand hygiene compliance and cleaning of non-critical equipment by audits and surveys.
  
  
• Timely feedback on MRSA rates and environmental sampling results to the clinical units.
  
  
• Working closely with the clinical managers and ward staff, to site product placement and ensuring that product is re-stocked.
  
  
• Involving Infection Control liaison members to promote the project across the hospital.   Liaison members assisted with auditing, education and implementation of interventions within their unit.
  
  
• Commitment and support from the infection control committee, executive sponsor, critical care director, visiting infectious Diseases Physician and microbiology laboratory.
  
  
• Involvement and participation of consumer groups (e.g. aged care and mental health).
  
  
• Good rapport and support from Supply, Engineering and Environmental Services Departments.
  
  
• Support from colleagues from the Infectious Diseases/Infection Control Departments at Austin Health.
  
  
• Promotion of the project through posters (designed by a cartoonist) combined with other material such as a hand hygiene brochure, challenging staff with quizzes, and painting of a mural on the canteen fridge.
  
  
• Guest speakers from Austin Health including Professor Lindsay Grayson (Professor of Infectious Diseases).
  
  
• Presence of an Infection Control Practitioner at daily ward rounds (critical care unit) improved and promoted hand hygiene.
  
  
• Promoting the project at staff orientation.