Impacting VRE Rates on a Hematopoietic Stem Cell Transplant Unit

Impacting VRE Rates on a Hematopoietic Stem Cell Transplant Unit

Abstract/Background
The prevention of hospital acquired infections is an ongoing performance improvement opportunity in our hematopoietic stem cell transplant (HSCT) population.  An outbreak of Vancomycin-Resistant Enterococci (VRE) occurred in late 2011 that extended through 2012.  A multidisciplinary approach to impact VRE has resulted in major improvement and sustained reduction in VRE rates in 2013.

Objective/Methods

1.       Multidisciplinary Integration

In order to achieve the goal of preventing Hospital Acquired Infections our program works closely with the hospital Infection Prevention (IP) team.  The IP team attends/reports unit data and opportunities to:

·         HSCT Quality Management Meeting (ad hoc)

·         Sarah Cannon Blood Cancer Network Infection Prevention Team and Quality Calls

·         Both the HSCT and the IP team participate in monthly IP Multidisciplinary Rounding

·         IP performs consultative review of IP specific HSCT Policies and Procedures

·         Conversely, HSCT team members attend monthly house wide IP Committee meetings

2.       IP and HSCT Quality Manager Performed an IRB Approved Study “Housekeeping Education on VRE Rates and Patient Satisfaction on a Bone Marrow Transplant Unit”

·         Housekeeping and Biomedical Engineering Staff were in-serviced by the Medical director of the HSCT program and the Infectious Disease Consulting Physician on the importance of environmental cleanliness in the transplant patient population.

·         Cleaning of the patient environment was observed and efficacy of the cleaning reported in real-time with 3M™ Clean-Trace™ NG Luminometer.

·         Rates of VRE colonization and HCAHPS scores for Cleanliness on the BMT unit were collected, analyzed and reported.

3.       Ongoing integration of Housekeeping and HSCT Nursing Leadership rounding and audits

4.       Revised In-Patient Visiting Restrictions

·         The IP team provided supporting data that visitors 14 years of age and over can follow basic precautions, infection control measures, don PPE appropriately.

·         All visitors are screened for illness prior to entry on the HSCT units.  If the individual is free of any signs/symptoms of illness they are provided a dated “guest” sticker and allowed entry into the unit. This process is repeated daily.

Results/ Conclusions:  Consistent multidisciplinary engagement and vigilance have reduced VRE rates on the in-patient HSCT unit.