1 eliminating mrsa infections plexus mrsa bundle:the how of staff engagement and culture change
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1
Eliminating MRSA Infections
Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change
20,000die every year
in the U.S. from
MRSA infections…
20,000
…more than die from AIDS
Public trust is eroding
MRSA Skyrockets in Washington State
Source: Seattle Times analysis; state Department of Health dateAmanda Rymond / The Seattle Times
Cases of hospital patients with MRSA have jumped 33-fold since 1997 in Washington state
33 fold
Where do you find
MRSA in Hospitals?Everywhere!
MRSA CAN be stopped!
MRSA incidence rates – Billings ClinicHousewide – January 1999 – December 2008
1st Jan, 2005 – 30th June, 2008
84%Reduction in HA MRSA infections
Active surveillance began in ICU Jan 2007
May 2006 PD/MRSA project began
84%
(4 people)
(9 people)
(14 people)
(20 people)
(33 people)
(38 people)
(34 people)
(14 people) (6 people)0.13
June - Dec
What’s it going to take to STOP spreading MRSA?
Preventing MRSA
infections is primarily a
complex social and
behavioral challenge
rather than a knowledge
or technical problem.
“
”
All invited and included
The Plexus MRSA Bundle helps you to get everyone to do their part
Social and Behavioural Change
Processes
Targeting Tools
Feedback Tools
Monitoring Tools
Learning Collaborative
Coaching for in-house facilitators
Engagement, engagement, engagement!
…in an array of proven social change processes, featuring Positive Deviance, designed to engage everyone in:
Discovering which of their practices can play
a role in the transmission of MRSA
Spreading effective practices, creating new
practices and deciding what changes they need to make personally and together
Targeting tools
…so that healthcare workers are able to identify which patients are MRSA positive and require contact precautions
This consists of actively
screening patients on
admission and providing
the results to hospital
units immediately
Feedback tools
…for healthcare workers to know how many transmissions have taken place on their unit
This consists of screening patients upon transfer or discharge and comparing
the results with admission data, then feeding this
information back to all staff members weekly
Monitoring tools
…for the staff to track their OWN performance with essential infection control practices on their unit
Staff may choose to track the percentage of swabbing at
admission, discharge or transfer and conduct periodic surveys on compliance with hand washing and standard
isolation precautions (gloving and gowning)
Learning collaborative
Every hospital implementing the Plexus MRSA Practice Change Bundle is connected with other facilities engaged in the same process and others who have already implemented it
Coaching for in-house facilitators make the change process sustainable long-term
The Plexus MRSA Bundle
6 to 12 months initiative
Bottom-up with top-down support
All invited and included
Self-discovery
Self-monitoring
Sustainable practices
Learning to find solutions
Dr. Jon Lloyd, Pittsburg VA
They all pointed at the ICP staff
When we asked the staff:Who is responsible for infection control?
A year later everyone raised his hand
“ ”
The Palmer Method
Jerry Zuckerman, MD, medical director of infection prevention and control, Albert Einstein Medical Center
I’ve seen more
change at Einstein
in the last six
months than in my
16 year career in
infection control.
“
”
Results
Healthcare associated MRSA
infection rates for
RWJF/Plexus pilot units from
2006 to 2008 declined
74%
Close to Zero
MRSA incidence rates – PD MRSA Intervention Unit - ICUJanuary 2004 – December 2008
2.61(13 people infected)
2.72(14 people infected)
2.76(14 people infected)
0.38(2 people infected)
0.20(1 person infected)
2004 2005 2006 2007 CY 2008Jan-Dec
4
3
2
1
0
Jan 1, 2006 – Jun 30 2008100% reduction in HA
MRSA infections
2006 –200786% decrease
2007 –2008100% decrease
2 others achieved reductions of
65-70%
While national rates
of MRSA HAI’s go
up, RWJ/Plexus PD
beta site rates are
going down.
“
”Dr. John Jernigan, CDC
How many $$$$ could you save by reducing MRSA infections?
MRSA infections result in…
Increased lengths of stay
Opportunity costs
Unreimbursed expenses
Potential liability
Long term benefits
HospitalReputation
Leadership Development
Break Down Silos
Liability/Risk Reduction
Reduction of MRSA Burden
Process Skills Applicable to Other Issues
The work of Plexus Institute initiative using
PD to fight MRSA in hospitals, was one of The
New York Times Magazine featured ideas
of the year for 2008
