Implementation of the Cystic Fibrosis Foundation infection control guidelines at a university healthcare system: A multidisciplinary approach requiring continuous quality improvement

Abstract

ISSUE: This university healthcare system provides comprehensive care for over 400 adult and pediatric cystic fibrosis (CF) patients, including lung transplantation for patients with highly antibiotic-resistant B. cepacia. Implementation of the CF Foundation guidelines was an important element of our comprehensive infection control program and used a framework of continuous quality improvement. PROJECT: Multiple activities were conducted and included: 1) evaluation of staff and institutional resources to support this intervention, 2) policy planning and development with a multidisciplinary CF advisory group, 3) focus group discussion with patients and family members of the lung transplant support group, 4) educational sessions for clinical staff, including nurses/physicians, physical therapy, respiratory care, and recreation therapy, 5) development of an electronic patient medical record notification system operated by epidemiology that alerts clinical staff and bed management of a CF patient's isolation status, 6) education for patients and families including a trifold color brochure explaining CF and contact isolation for both inpatient and outpatient settings, 7) support from legal services to establish our obligations and response to the noncompliant patient or family member, and 8) point prevalence surveys to assess compliance with isolation policies with staff feedback. Tabled 1 March 04 October 04 Staff Visitors Staff Visitors Gloves 91% 37% 92% 43% Gown 85% 47% 96% 60% Open table in a new tab LESSONS LEARNED: Institution of a new infection control policy requires the basic components of program development: needs and resource assessment, planning and policy development, implementation, and evaluation. To succeed, the policy must be structured using a continuous quality improvement framework with ongoing assessments and modifications. Staff ownership of the policy and input and support from the CF population were keys to this policy's effectiveness and acceptance. ISSUE: This university healthcare system provides comprehensive care for over 400 adult and pediatric cystic fibrosis (CF) patients, including lung transplantation for patients with highly antibiotic-resistant B. cepacia. Implementation of the CF Foundation guidelines was an important element of our comprehensive infection control program and used a framework of continuous quality improvement. PROJECT: Multiple activities were conducted and included: 1) evaluation of staff and institutional resources to support this intervention, 2) policy planning and development with a multidisciplinary CF advisory group, 3) focus group discussion with patients and family members of the lung transplant support group, 4) educational sessions for clinical staff, including nurses/physicians, physical therapy, respiratory care, and recreation therapy, 5) development of an electronic patient medical record notification system operated by epidemiology that alerts clinical staff and bed management of a CF patient's isolation status, 6) education for patients and families including a trifold color brochure explaining CF and contact isolation for both inpatient and outpatient settings, 7) support from legal services to establish our obligations and response to the noncompliant patient or family member, and 8) point prevalence surveys to assess compliance with isolation policies with staff feedback. LESSONS LEARNED: Institution of a new infection control policy requires the basic components of program development: needs and resource assessment, planning and policy development, implementation, and evaluation. To succeed, the policy must be structured using a continuous quality improvement framework with ongoing assessments and modifications. Staff ownership of the policy and input and support from the CF population were keys to this policy's effectiveness and acceptance.