scholarly journals Modified Veterans Health Administration Clostridioides difficile Infection (CDI) Prevention Bundle: Progress Over 8 Years Decreasing CDI Laboratory-Identified (LabID) Events at a Large Veterans Affairs Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s319-s319
Author(s):  
Patricia Byers ◽  
Andrew Hunter ◽  
Edward J. Young ◽  
Sherri-Lynne Almeida ◽  
Karen Stonecypher ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antimicrobial Stewardship ◽  
Veterans Health Administration ◽  
Team Approach ◽  
Veterans Health ◽  
Case Review ◽  
Health Administration ◽  
Care Providers ◽  
Core Measures ◽  
Community Onset

Background: In March 2012, the Veterans’ Health Administration (VHA) published the Guideline for the Prevention of Clostridium difficile infection (CDI) in VHA Inpatient Acute-Care Facilities, with a goal of 30% reduction of cases within 2 years. In March 2011, this facility, along with 31 others, served as a pilot site to develop the guidelines. Methods: The CDI prevention bundle was implemented to prevent new onset CDI cases in the facility with 4 core measures: (1) environmental cleaning (EMS), (2) hand hygiene, (3) contact precautions, and (4) cultural transformation. Education was provided to EMS staff, nursing, and care providers on the CDI case definition, criteria for testing, empiric isolation for patients with diarrhea, hand hygiene, and PPE to control spread. In 2014, antimicrobial stewardship was added, and within 5 years an algorithm for isolation and testing was published. Cases were reviewed weekly using TheraDoc software and were reported monthly to the national VHA Inpatient Evaluation Center (IPEC). Isolation was communicated using a ward roster/isolation list in TheraDoc for all unit champions to consult daily. CDI cases were classified using NHSN definitions for a laboratory-identified (LabID) event, recurrent cases, and community-onset cases. Real-time case review and weekly multidisciplinary case discussions identified opportunities for improved compliance with the core measures. Results: Over an 8-year period, CDI healthcare-onset LabID events decreased by 73%. The cases decreased from 149 to 40 over the 8-year period. The infection rate decreased 70% from 16.19 per 10,000 bed days of care in FY2011 (October 2010) to 4.88 in FY2019. The incidence of community onset infections increased from 75 in FY2011 to a high of 146 in FY2018 for a rate of 8.15 to 18.17. In FY2019, there was a decrease in both LabID events and community-onset cases to lows of 40 and 102, respectively. Inappropriate testing decreased by 84% from 50 in FY2011 to 8 in FY2019. Conclusions: A multidisciplinary team approach that included support from leadership and clinical providers as well as front line staff involvement, daily rounding, and case review by infection preventionists has reduced all CDI cases over an 8-year period using the modified VHA CDI bundle. TheraDoc enabled case review, correct isolation, changes to cleaning practices, and more appropriate lab testing. The antimicrobial stewardship program that includes clinical pharmacists working daily with providers was a strong driver for change.Funding: NoneDisclosures: None

Communication and psychological safety in veterans health administration work environments

2014 ◽  
Vol 28 (6) ◽  
pp. 754-776 ◽  
Author(s):  
Nancy J. Yanchus ◽  
Ryan Derickson ◽  
Scott C. Moore ◽  
Daniele Bologna ◽  
Katerine Osatuke
Keyword(s):  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Psychological Safety ◽  
Veterans Health Administration ◽  
Employee Perceptions ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Content Type

Purpose – The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Design/methodology/approach – Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Findings – Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Originality/value – Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

Design Concepts to Support Management of Outpatient Consultations in the Veterans Health Administration

2016 ◽  
Vol 60 (1) ◽  
pp. 1475-1476 ◽  
Author(s):  
Laura Militello ◽  
Julie Diiulio ◽  
Alissa Russ ◽  
April Savoy ◽  
Mindy Flanagan ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Poster Session ◽  
Primary Care Providers ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Design Concepts ◽  
Present Design

This poster describes a project to improve understanding of the challenges associated with managing consultations in the Veterans Health Administration (VHA). We conducted interviews and observations with primary care providers and specialists at two VHA facilities. Using qualitative analysis, we identified cognitive requirements, challenges associated with each, and design seeds. During the poster session, we will present design concepts exploring interventions to support management of consultations.

Comprehensive survey of hand hygiene measurement and improvement practices in the Veterans Health Administration

2013 ◽  
Vol 41 (11) ◽  
pp. 989-993 ◽  
Author(s):  
Heather Schacht Reisinger ◽  
Jun Yin ◽  
Lewis Radonovich ◽  
V. Troy Knighton ◽  
Richard A. Martinello ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Comprehensive Survey

scholarly journals Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014

2018 ◽  
Vol 46 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Kelly R. Reveles ◽  
Mary Jo V. Pugh ◽  
Kenneth A. Lawson ◽  
Eric M. Mortensen ◽  
Jim M. Koeller ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Community Onset

scholarly journals 227. Epidemiology of bloodstream infections in Veterans Health Administration, 2010-2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S221-S222
Author(s):  
Aditya Sharma ◽  
Patricia Schirmer ◽  
Cynthia A Lucero-Obusan ◽  
Gina Oda ◽  
Mark Holodniy
Keyword(s):  
Positive Culture ◽  
Bloodstream Infections ◽  
Veterans Health Administration ◽  
Annual Incidence ◽  
Veterans Health ◽  
Health Administration ◽  
E Coli ◽  
Extended Spectrum ◽  
Healthcare Associated ◽  
Community Onset

Abstract Background National trends of bloodstream infections (BSI), their etiologies, and prevalence of resistance are not well described. We reviewed BSI during 2010-2020 in the Veterans Health Administration (VHA), the largest healthcare system in the United States. Methods Demographic, microbiological, and healthcare exposure data were extracted from VHA databases. A case was defined as isolation of a microbe from blood specimens collected from a hospitalized person; common commensals required matching organisms isolated within two consecutive days. The first organism-specific episode within a 14-day period was counted. Staphylococcus, Enterococcus, S. pneumoniae, and gram-negative isolates were assessed for resistance to methicillin, vancomycin, any antimicrobial, and extended-spectrum cephalosporins or carbapenems, respectively. Cases were classified as community acquired (CA-), healthcare-associated community onset (HCO-), and hospital onset (HO-). Trends were estimated by generalized linear mixed models. Results During 2010-2020, incidence of CA-BSI decreased from 42.2 to 27.6 per 100,000 users, HCO-BSI decreased from 63.7 to 40.7 per 100,000 users, and HO-BSI decreased from 28.2 to 16.4 per 100,000 users (Figure 1A). S. aureus and E. coli were the most common in CA-BSI and HCO-BSI; S. aureus and Enterococcus were the most common in HO-BSI; the prevalence of E. coli increased in BSI across classifications (Figure 1B). Incidence of BSI caused by resistant Pseudomonadales and Enterococcus decreased by more than 15% annually; annual incidence of BSI caused by other organisms decreased by less than 10% or remained unchanged with the exception of extended-spectrum cephalosporin resistant E. coli, which increased 6% annually (Figure 2). HO-BSI were more resistant than CA-BSI and HCO-BSI across organisms; resistance among E. coli and S. pneumoniae BSI increased across classifications (Figure 3). Figure 1. Trends of bloodstream infections by organism in Veterans Health Administration, 2010-2020. (A) Incidence per 100,000 users. (B) Percentage of incident BSI by organism. Trends are adjusted for distributions of age, gender, and number of users, in addition to accounting for clustering by county and facility. Community acquired: positive culture collected less than 4 days after hospitalization from a person without previous healthcare exposures. Healthcare-associated community onset: positive culture collected less than 4 days after hospitalization from a person with previous healthcare exposures. Hospital onset: positive culture collected 4 or more days after hospitalization. Figure 2. Percentage change in annual incidence of bloodstream infections by organism in Veterans Health Administration, 2010-2020. Dots represent point estimates and horizontal bars represent 95% confidence intervals. Figure 3. Trends in prevalence of resistance among organisms causing bloodstream infection by epidemiological classification in Veterans Health Administration, 2010-2020 Trends are adjusted for distributions of age, gender, and number of users, in addition to accounting for clustering by county and facility. Community acquired: positive culture collected less than 4 days after hospitalization from a person without previous healthcare exposures. Healthcare-associated community onset: positive culture collected less than 4 days after hospitalization from a person with previous healthcare exposures. Hospital onset: positive culture collected 4 or more days after hospitalization. Conclusion BSI incidence decreased during 2010-2020 across classifications. CO-BSI and HCO-BSI occurred more frequently and were less resistant than HO-BSI. S. pneumoniae and E. coli BSIs became more resistant over time. Increasing incidence of BSI caused by E. coli resistant to extended-spectrum cephalosporins warrants urgent investigation. Disclosures All Authors: No reported disclosures

scholarly journals Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

2018 ◽  
Vol 39 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Katie J. Suda ◽  
Daniel J. Livorsi ◽  
Michihiko Goto ◽  
Graeme N. Forrest ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Research Agenda ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration
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