Multidisciplinary Environment of Care Rounding to Mitigate Water Related Pathogens in the ICU

Abstract

<h3>Background</h3> This project occurred at a 1010-bed tertiary academic hospital in the southeast. The Centers for Medicare and Medicaid Services issued a memorandum in June 2017 requiring healthcare facilities to reduce Legionella risk. This implies that healthcare facilities are responsible for identifying risks and preventing infections related to waterborne pathogens (WRP). WRP were screened from January 2018-March 2019 in the 17 bed Surgical Trauma Intensive Care Unit (STICU) with a baseline monthly average of 0.2. In April-June 2019 an increase was identified, including two colonizations and four infections. Multiple factors impacted this increase, including respiratory equipment storage, plumbing issues, sink storage, and Environmental Services (EVS) deficiencies. <h3>Methods</h3> A multidisciplinary team assembled to begin Environment of Care interventions in June 2019. Included were Infection Prevention (IP), Respiratory Therapy (RT), Facilities, Industrial Hygiene (IH), and EVS. RT initiated bedside anti-humidity measures by initiating the use of a new nebulizer mouthpiece for our vented patients and running continuous 1/2 liter of oxygen through stored equipment. Facilities committed to enhanced response times with IH mitigating challenging plumbing concerns. Nursing and IP initiated daily assessment of all STICU rooms. EVS initiated adenosine triphosphate testing of all terminally cleaned rooms. Biweekly multidisciplinary rounding began in August 2019. In September 2019, filters were installed on all STICU room faucets. <h3>Results</h3> Identification of WRP pathogens returned to baseline in July 2019-November 2019. Ongoing assessment notes continuation of this trend. <h3>Conclusions</h3> Multidisciplinary Environment of Care interventions and rounding reduces WRP in the ICU setting.