Michelle Schmitz

Success of a multimodal program to improve hand hygiene compliance.

The purpose of this article was to describe the successful implementation of a quality improvement initiative focusing on a hand hygiene program that used the multimodal interventions of tailored education, monthly feedback, and reminders. Compliance rates improved from July 2011 to December 2012 by 57.4%. Efforts are continuing to ensure program sustainability.

Clostridium difficile in a children's hospital: Assessment of environmental contamination

Clostridium difficile infection (CDI) is the most frequent infectious cause of health care-associated diarrhea. Three cases of CDI, in children age 2, 3, and 14 years, occurred in the hematology/oncology ward of our childrens hospital over 48 hours. We aimed to assess environmental contamination with C difficile in the shared areas of this unit, and to determine whether person-to-person transmission occurred. C difficile was recovered from 5 of 18 samples (28%). We compared C difficile isolated from each patient and the environment using pulsed-field gel electrophoresis, and found that none of the patient strains matched any of the others, and that none matched any strains recovered from the environment, suggesting that person-to-person transmission had not occurred. We found that C difficile was prevalent in the environment throughout shared areas of the childrens hospital unit. Molecular typing to identify mechanisms of transmission is useful for devising appropriate interventions.

Using a Systems Engineering Initiative for Patient Safety to Evaluate a Hospital-wide Daily Chlorhexidine Bathing Intervention.

We undertook a systems engineering approach to evaluate housewide implementation of daily chlorhexidine bathing. We performed direct observations of the bathing process and conducted provider and patient surveys. The main outcome was compliance with bathing using a checklist. Fifty-seven percent of baths had full compliance with the chlorhexidine bathing protocol. Additional time was the main barrier. Institutions undertaking daily chlorhexidine bathing should perform a rigorous assessment of implementation to optimize the benefits of this intervention.

The relationship between patient functional status and environmental contamination by Clostridium difficile : a pilot study

IntroductionLimited data exist on patient factors related to environmental contamination with Clostridium difficile.MethodsWe evaluated the association between the functional status of patients with C. difficile infection (CDI) and environmental contamination with C. difficile.ResultsContamination of patient rooms was frequent and higher functional status was associated with contaminated surfaces remote from the bed. All but one environmental isolates matched the corresponding patient’s stool isolate for the seven patients tested.ConclusionFunctional status is a factor that influences environmental contamination with C. difficile. Future studies should evaluate strategies to reduce contamination in CDI patient rooms, taking into account the patient’s functional status.

Optimal Compliance with Hand Hygiene Remains a Challenge in Healthcare Institutions

Project: It was the goal of the Infection Control Department to design a newmodel of delivering education hospital wide. Of key importance was to develop a model that met the following HCW needs: 1) Method chosen should demonstrate a respect for the busy HCWs time, 2) The system should be portable/mobile, 3) Inservices should be convenient and designed to be less than 10minutes in length, 4) Incentives for theHCWshould be used tomake the program fun, entertaining and one that would leave a lasting impression, 5) The education model should be user friendly for the busy IP, utilizing a self-containedmobile cart, and 6) Themobile cart should be easily recognizable to the HCW and visually promote the educational program.