Calling all “I-cops”: Bone marrow transplant unit's vancomycin-resistant Enterrococcus (VRE) outbreak arrested through the use of infection control “cops”

Abstract

ISSUE: VRE surveillance cultures have been routinely performed on patients in a bone marrow transplant unit with a low endemic VRE rate. An increase in colonized/infected patients was identified. Traditional infection control/education methods failed to stem the outbreak. A massive, three-tiered, 24-hour approach was created and successfully employed. PROJECT: A multidisciplinary VRE control team, comprised of infection control, hospital epidemiologist, bone marrow transplant unit (BMTU) and ancillary staff, environmental services, administration, and physicians identified the need to develop an aggressive approach. All aspects of the patient experience, inpatient and outpatient, were targeted. The infection control team performed a reassessment of the continuing problem. The "I-COP" program was created as an answer to meet the identified needs. A team of nurses, specially trained by the ICP, were nicknamed the infection cops, or "I-cops." With administrative support, I-cops were scheduled around the clock and provided dedicated, 24 hour/day individualized education. Positioned at the entrance to the BMTU, the I-cops targeted entering staff, physicians, patients, and visitors. Education included hand hygiene, donning and removal of PPE, and review of isolation and VRE policies and procedures. Return demonstration of handwashing and PPE garbing/removal techniques was required. Environmental staff demonstrated knowledge of terminal cleaning, "wet-bucket" procedure before working in the unit. This system was employed by the outpatient clinics, with emphasis on use of waterless handwash during the patient's office visit and the same environmental cleaning requirements. I-COPs were empowered to monitor for compliance and given the authority to take corrective on-the-spot action. A record was kept of all I-cop activities. The infection control department provided ongoing guidance. RESULTS: Since the beginning of the I-cop program, healthcare-associated VRE colonization cases have been "arrested." Environmental cultures have been negative. The staff has incorporated learning into daily practice. LESSONS LEARNED: Increased IC presence via I-cops on a 24-hour basis, with the requirement of return demonstration of infection control practice for all, turned the tide in the battle of VRE colonization in this unit. Administrative support and multidisciplinary leadership provided means and support. A "back to basics" approach to infection control practice was of benefit to even the most dedicated and seasoned employees.