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State Tackles Winnable Battle with Innovative Acute and Long-Term Care Partnership

Posted on by CDC's Safe Healthcare Blog
Patsy Tassler Kelso, Ph.D.
Patsy Tassler Kelso, Ph.D.

Guest author – Patsy Tassler Kelso, Ph.D.
Vermont Department of Health – Infectious Disease

Vermont is taking on an exciting new project to prove that preventing healthcare-associated infections is a “winnable battle.”

We recognize that infections occur in all healthcare settings, and that multi-drug resistant organisms (MDRO) can travel with patients. That’s why the Vermont Department of Health, in partnership with CDC, Vermont Program for Quality in Health Care, and healthcare facilities statewide have formed the Vermont MDRO Prevention Collaborative. Our collaborative is bringing hospitals and nursing homes together in this effort – getting front-line staff to share ideas, bringing acute care infection prevention experience into long-term care settings.

Why nursing homes? Vermont has only 14 hospitals, and half are small critical access facilities. There are almost 3 times as many long-term care facilities providing skilled nursing care; they are a key partner. We’re proud to say that every Vermont hospital, along with one hospital in New Hampshire, and more than three-quarters of the nursing homes with skilled nursing facilities have joined the collaborative.

We grouped these facilities into 13 healthcare “clusters.” Each cluster has at least one hospital, plus the local long-term care facilities that use that hospital’s lab. These facilities care for the same communities, and therefore they address MDROs and will measure the impact of their efforts together as a team.

Clusters are using some proven, well-established interventions as well as some cutting-edge ones. The strategies we’ve asked them to consider include: active identification and specific management for patients carrying MDROs, use of standard communication about patients carrying MDROs as they move among facilities, minimizing use of devices and antibiotics that can increase MDRO risk, and enhancing infection prevention activities. Each cluster decides which interventions are feasible in their facilities and works together on implementation.

Though the clusters have only been working together for 3 months, we see exciting benefits. Participants have visited the other facilities in their clusters – often for the first time. They’ve seen firsthand some of the challenges their partners face, and identified common areas to address as a team. Everyone involved is sharing experiences and resources to make Vermont healthcare safer and better coordinated.

Vermont healthcare facilities have made a huge commitment to this year-long collaborative. We at the health department are proud to support their efforts and ensure their accomplishments continue beyond official timeline of this project.

Posted on by CDC's Safe Healthcare Blog

5 comments on “State Tackles Winnable Battle with Innovative Acute and Long-Term Care Partnership”

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    It’s truly a great and useful piece of information. I’m glad that you simply shared this helpful tidbit with us. Please keep us up to date like this. Thanks for sharing.

    I am impressed that the VT coallition includes LTC facilities. Since many if not most colonized and/or infected patients entering acute care facilities come from these facilities, it is important to include them in aggressive education and prevention practices. Little has been done in this part of the healthcare arena.

    Sadly healthcare consumers are missing from the ranks of this collaborative.

    Bravo. This collaborative is a great beginning. It sounds like much good has resulted from it already. The challenge will be keeping it going in an era of tight budgets at the state level. But programs like this are needed in every state, including California. Here in California, we are trying to move as many members of the developmental disability community as possible out of workshops and day programs and into supported employment with job coaches in integrated community work at at least minimum wage. One of the places that are hiring is hospitals for catheteria/kitchen service, laundry, janitorial, and similar jobs and also volunteer placements. Information on how to prevent the spread of health care related illnesses needs to get out to everyone on the hospital team . For members of the disability community on staff, this might mean that critical information is available in alternative formats including a version using simplified language and pictures to explain complex ideas, an audio version, and a Large Print version. Members of the disability community in the hospital as patients also need access on steps to take to help protect themselves from health care leated illnesses and there needs to be alternative formats available for them as well. I am also glad the nursing homes are participating. Nursing home participation is of critical importance. Hopefully, the program can be expanded at some point to include the dialysis centers. Best wishes, Michael E. Bailey.

    I would love to see ESRD Dialysis Facilities included considering dialysis patients average two hospitalizations a year, from recall. Additionally, with infection the number two killer in this vulnerable population, and perhaps some of these patients being nursing home residents, it would be prudent to include dialysis facilities. There are about eight dialysis facilities in Vermont. To my understanding, five of these have 9 dialysis chairs, one has 10, one has 19 and one has 13. I believe that all have several shifts, except for two.

    Dialysis patients deserve the same consideration in keeping them safe and with CMS having no real sanctions in place to prevent errors, including, but not limited to infections, these patients need all the protection we can give them.

    Roberta Mikles
    San Diego, CA

    It’s a great idea – our research team calls this idea “germ shed management.”

    Unfortunately, these types of collaboration frequently run afoul of the Stark II and Anti-Kickback laws which prevent most financial relationships between referral sources. Do the hospitals in any way support infection control in the LTC facilities?

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