On 12/3/2009 UK Software company said:

Quite inspiring, Keep up the good work, Thanks

On 9/15/2009 Buddy said:

Pam.. I have a risk assessment that you could use. Its very simple as I am the ICO for a psychatric hospital as well. Let me know a way to email it to you and it's yours.

On 9/3/2009 Pam Rohrbach said:

I also have a question regarding the MDRO risk assessment as we are a psychiatric facility surveyed under the hospital requirements. We do not have a great deal of MDRO issues and I am finding it dificult to find a risk assessment that fits our particular kind of setting as we do not do surgical procedures, do not have ICU's etc. Any thoughts ??

On 8/18/2009 Karen Iversen - JCR said:

Thank you everyone for participating today - we encourage you to keep your eyes on the blog for any questions that required more follow-up. In addition, we look forward to our next interactive session on September 1st. Thank you!

On 8/18/2009 Barbara Soule said:

Doris, this is an excellent question. The toolkit was designed for both large complex and small hospitals and the authors and the review team do consider it important for all size hospitals to reduce antibiotic resisntance and MDROs. I certainly understand the issue of limited resources. One way to think about this is that preventing infections with MDROs will prevent costs of care, which can be quite expensive, and save money for the hospital, not to mention morbidity and mortality for patients. So, reducing MDROs is a good investment. I encourage you to move forward and do what you can to use the toolkit to help reduce antibiotic resistance in your organization. Best regards, Barb

On 8/18/2009 Barbara Soule said:

Susan, thank you for bringing up that point. Actually you are correct and I should have emphasized your comment about ""recommend versus "require." My apologies. What the Joint Commission wants to see is that an organization follows evidence-based guidelines. If they choose not to follow the published guidelines they can show that they are providing the same level of safety and quality of care to patients and staff they will look at that during survey. So, if exceptions are made to the EVB guidelines the organization will need to have data or information to demonstrate that this is a reasonable approach. The parameters you mention in your note are excellent. Thanks again for bringing that up. For the final word on this issue I will check awsk the Standards Interpreation Group (SIG) to consider posting an FAQ on this for others. If you send me your email I will get back to you. Thanks again, Barb

On 8/18/2009 Susan said:

Could you please clarify: Doesn't the CDC "recommend" rather than require? New data seems to suggest that if MDRO rates are low, hand hygiene compliance is high, cleaning practices are rigorous, and Standard precautions are emphasized, then the guidelines can be modified or adapted to the facility's needs (as stated in the guidelines).

On 8/18/2009 Doris McKindle said:

I am from a small hospital and we don't have a lot of resources to support new initiatives. Is this really important for a smaller org, or is the toolkit meant for large academic settings?

On 8/18/2009 Barbara Soule said:

Virginia, great question. The importance of the SCIP measures is that they monitor 3 important processes of care that have been shown to affect the incidence of surgical site infections. Often the OR staff take over the monitoring of these measures but infection prevention and control (IPC) performs them in some hospitals. IPC staff should at the very least receive the information about the percent compliance with timing of antibiotics prior to incision, use of the most appropriate antibiotic and discontinuing the antibiotics within 24 hours(in most cases). When compliance targets are not met, the infection control committee,the surgical and anesthesia services and pharmacy and others should collaborate to improve practice. It is possible to achive very high compliance with these measures and that is what each organization should aim for. Thanks much, Barb

On 8/18/2009 Virginia Hillburger said:

How should infection control be involved w/the use of SCIP approved antibiotics for surgical cases?

On 8/18/2009 Virginia Hillburger said:

How should infection control be involved w/the use of SCIP approved antibiotics for surgical cases?

On 8/18/2009 Barbara Soule said:

Virginia, can you restate your question? Not sure what you are asking. Thanks, Barb

On 8/18/2009 Virginia Hillburger said:

Can we expound upon keeping infection control with the use of SCIP approved antibiotics for surgical cases?

On 8/18/2009 Barbara Soule said:

Betty, in the development process we had many CEOs and senior administrators review the toolkit. It was well received. We are working to engage senior leaders in the hospital community involved. I think it will take more than just sending the toolkit to the leaders to engage them. Someone needs to sit down and talk about the importance of this issue, the clinical and cost outcomes and what support is needed from them to make positive and successful change. So, suggest you make an appointment with the senior leader for infection prevention and control to have a chat and show a few tools! Also, don't forget the audioconferences and these blogs, especially the one on financial impact of antibiotic resistance. Good luck! Barb

On 8/18/2009 Karen Iversen - JCR said:

Hello Trish: Thank you very much for your inquiry! Visit the same site where you downloaded the PSF version of the toolkit book. On the right-hand side of the screen, it says "Tools for the CD Rom." The tools are located by chapters. You may download the tools and save them to your computer.

On 8/18/2009 Betty Madison said:

What feedback have you heard from health care LEADERS about this toolkit? Has it been well-received? (I passed it along to my CEO but I haven't heard a response yet...)

On 8/18/2009 trish kovalenko said:

I have the print out of the tool kit. How can I get the CD with the spreadsheets, etc?

On 8/18/2009 Barbara Soule said:

Trish, the Joint Commission follows the CDC Guidelines for Isolation Precautions and expects organizations to do the same. These are evidence-based guidelines. The CDC requires a gown upon entering the room where contact precautions are in place. The reason for this is that there is sometimes unanticipated contact with the environment or patient so wearing a gown prevents clothing or skin contamination. Thanks, Barb Barb

On 8/18/2009 Barbara Soule said:

Donna, this is a complicated treatment question and I would prefer to refer you to Dr. Weber or Dr. Talbot when they host their blogs. Tune in then! Barb

On 8/18/2009 Barbara Soule said:

Melvin, I think your approach with your patient population sounds excellent. The only other thoughts I have is to make sure the environmental cleaning around patients who have MDROs (and all patients for that matter) is sufficient to remove surface organisms that can exist for hours to weeks. Also, be sure your staff are well educated about MDROs and think about them as they care for the patients. Increased awareness can help. Of course, use gloves and other PPE when necessary. Hope this helps, Barb

On 8/18/2009 Melvin Berry said:

I am the Infection Preventionist in a moderate size state psychiatric hospital that admits both forensic patients from county jails from across our state and civil patients from a catchment area that is larger than most states. We have a work practice where we culture any draining wound that a patient comes in with. This is an attempt to identify and stop the potential spread of MDROs. Due to behavioral issues related to our patients many times it is very difficult to use contact isolation with them. We have instituted a practice of contact precautions where we cover the draining would, stress hand hygiene and social distancing. We are 11+ months into our fiscal year and have had one healthcare associated MDRO in our hospital. Do you have any other suggestions that may be helpful in prevening the spread of MDRO in our unique setting. Thank you

On 8/18/2009 Barbara Soule said:

Moises, Louise Kuhny and I just finished an audio conference on the new NPSGs 7, including MDRO and in it we try to make clear what is required and what is optional or can be organization-specific for compliance. The audio conference is free to accredited organizations and can be found on your organization's extranet website. I think that will be informative and answer your questions. Barb

On 8/18/2009 Barbara Soule said:

Hi Karen, Great question. We are all concerned about cost of MDROs. I'd like to direct you to the toolkit in Chapter 2 where we have a great tool called the Burden Calculator. This is how we propose you calculate the costs. This is an excel document that you can customize with your organization data or data from the literature to calculate costs. Dr. Stephen Weber will be going over that in the blog session for Chapter 2 and also he reviewed it in the free audio conferences that are available on the JCR website. Barb

On 8/18/2009 Donna Sears said:

Do you have any recommendations on treatment options for a patient who continues to get skin abscesses that must be lanced. Patients may be treated with antibiotics but continue to get relapses. After antibiotics have been completed, if the MRSA screen(nares)is negative for colonization would you still implement a decolonization protocol.

On 8/18/2009 Trish kovalenko said:

Should gowns be required upon entering a contact precaution room, or can they be donned with anticipated contact with patient and environment? Does each facility have some freedom im implementing various precautions ( such as active infections vs. colonization) based on their situation and infection rates?

On 8/18/2009 Melvin Berry said:

I am the Infection Preventionist in a moderate size state psychiatric hospital that admits both forensic patients from county jails from across our state and civil patients from a catchment area that is larger than most states. We have a work practice where we culture any draining wound that a patient comes in with. This is an attempt to identify and stop the potential spread of MDROs. Due to behavioral issues related to our patients many times it is very difficult to use contact isolation with them. We have instituted a practice of contact precautions where we cover the draining would, stress hand hygiene and social distancing. We are 11+ months into our fiscal year and have had one healthcare associated MDRO in our hospital. Do you have any other suggestions that may be helpful in prevening the spread of MDRO in our unique setting. Thank you

On 8/18/2009 Moises Carpio said:

Would TJC consider what are the "must" do interventions and the "optional-recommended" interventions to fulfill the requirement of NPSG 7 regarding prevention of MDRO ? Thank you

On 8/18/2009 Karen Hilmy said:

In the section for Enhanced Risk Assessment of Antibiotic Resistance and MDROs do you have a recommendation of how to calculate the cost of MDROs listed as a recommendation in that section?

On 8/18/2009 Barbara Soule said:

Hi Dawn, nice to hear from you. In response to your question, the Joint Commission does not provide direction on how to perform the risk assessment for MDROs. In the toolkit, we mention that you can either make it part of your overall infection prevention and control program risk assessment or you can make it a separate document. The key is to think about the factors you want to assess that can contribute to MDROs and antibiotic resistance or those that can prevent these issues and incldue them in your assessment process. Check out the toolkit for more specific guidance and ideas in the Chapter Antibiotic Resistance: Patients and Hospitals in Peril. Barb

On 8/18/2009 Dawn Canterbury said:

I have a question regarding doing a MDRO Risk Assessemnt, I include a section covering MDRO's on my Infection Control Risk Assessment is this enough, or should I be doing a seperate one specifically on MDRO's? Also love the tool kit.....