1 Eliminating MRSA Infections Plexus MRSA Bundle:The HOW of Staff Engagement and Culture Change

20,000 die 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 date Amanda 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 Clinic Housewide – January 1999 – December st Jan, 2005 – 30 th June, % 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 - ICU January 2004 – December (13 people infected) 2.72 (14 people infected) 2.76 (14 people infected) 0.38 (2 people infected) 0.20 (1 person infected) CY 2008 Jan-Dec Jan 1, 2006 – Jun % reduction in HA MRSA infections 2006 – % decrease 2007 – % 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 Hospital Reputation Leadership Development Break Down Silos Liability/Risk ReductionReduction of MRSA BurdenProcess 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

Plexus Institute Call us: Want to learn more?