Presentation Number 112 Changing Bedside Care by Linking Outcome and Process Data

findings. Project: In a large Veterans Affairs Medical Center, a two- year project was initiated to develop a checklist assessing CPG practices, conduct assessments of CPG practices and test tool reliability, plan and implement strategies to involve HCPs in data collection, examine outcome and process findings, and evaluate changes in level of risk factors for infection. The checklist, called a Clinical Practice Assessment Tool (CPAT), is based on CPG expectations related to hand and environmental hygiene, isolation precautions, urinary device and central line management, and specimen collection. Expanded CPATs were developed for specialty areas such as dialysis and Surgical Service. The method for data collection in acute, long- term care, and mental health units involves weekly observations by the Infection Prevention and Control (IPC) Coordinators, though unit staff persons have also been encouraged to participate. Quarterly observations are made in surgical and dialysis areas. Statistical process control charts are used to examine time-series patterns of outcome data and CPAT scores. Both outcome and process data are entered into a grid to compare risk levels between clinical areas and between surgical procedures. A system of continuous data feedback with HCPs, attendance at nurse manager meetings, communication via 2-Way Memorandums with physicians, training of HCPs on CPGs, and strategic planning to overcome barriers for effective practices has guided practice changes. Results: The increased interaction of IPC Coordinators as part of the clinical unit teams was one of the strongest results from this project. Two- way communications between the HCPs and the IPC Coordinators increased along with shared responsibilities for problem solving. Health care- associated transmissions of Methicillin Resistant Staphylococcus aureus (MRSA), gram negativeresistant organisms, and Clostridium difficile decreased by 50 percent (50%) to 90 percent (90%) after implementation of the project. The rates for central line-associated and dialysis related bloodstream infections also decreased by sixty-six percent (66%) and eighty percent (80%) respectively. Minimal changes in surgical site infection (SSI) rates, specifically for colon surgeries, were noted. Lesson Learned: IPC Coordinator visibility and interaction with staff focused on process improvements are critical. Process data is