How St. Luke's Boise successfully switched cleaners, lowered C. diff rates

Three tips from St. Luke's Boise on how to successfully switch disinfectant cleaners and lower infection rates.

Clostridium difficile is a chronic problem throughout the healthcare industry, as nearly 500,000 Americans get a C. diff infection each year even though this infection is generally preventable.

Even though St. Luke's Boise (Idaho) Medical Center has had lower-than-average C. diff infection rates, officials at the hospital are still focused on preventing deadly infections caused by the bacteria.

"We have always worked on C. diff rates and how to improve them. Even though they were fairly good, [we were] never satisfied with the status quo," says Nikki Grae, director of quality and patient safety at St. Luke's Boise Medical Center.

St. Luke's C. diff infection rates hovered around 8.4 infections per 10,000 patient days. To lower that rate, the hospital first turned to cleaning all high-touch objects with bleach, which is very effective at killing C. diff. But there were several issues with using bleach extensively as a cleaner, according to Meredith Hotchkiss, RN, the hospital's environmental services director.

"The smell was really bothering people," Ms. Hotchkiss says. The smell and surface burns associated with bleach even led to a few workers compensation claims at the hospital.

Additionally, the bleach was starting to damage some of the finishes in the hospital, and the hospital wasn't seeing the reduction in C. diff rates that it wanted by using the bleach-heavy protocol.

Moving away from bleach

Because of the issues associated with the increased use of bleach and the lack of results, hospital officials decided the next course of action would be to move away from the chemical and start using a bundled approach with a different cleaner.

The bundled approach involved targeting hand hygiene compliance and antimicrobial stewardship, as well as switching to OxyCide, a disinfectant cleaner from Ecolab Healthcare.

"We were told about a new disinfectant [that] was supposed to be much better for finishes and for health," Ms. Hotchkiss explains. "For the health of our staff and our patients and the appearance of our facility, we decided to do it."

Tips for changing cleaners

The new cleaner had definite advantages. It came pre-mixed, unlike bleach, and it did not degrade surfaces. Additionally, changing cleaner led to a decrease in patient room turnover times, since environmental services did not have to clean with bleach and then again with another disinfectant, and the number of cleaner-related workers compensation claims dropped to zero.

There were some bumps in the road when it came to switching over, however. The new cleaner smells different then bleach — more of a vinegar smell — and it took some time for staff and patients alike to get used to that.

"You can't over-communicate that it's the 'new smell of clean,'" Ms. Hotchkiss says of jumping that hurdle. Also, she adds, "the more you use it, the less it smells."

According to Ms. Hotchkiss and Ms. Grae, changing cleaners to a new disinfectant isn't just as simple as putting the new cleaner on carts and calling it a day.

"Any change is difficult," says Ms. Hotchkiss. She and Ms. Grae say they owe the success of this change and the program to the following:

Having the right evidence to support the change. When asking someone to change their processes, it is important to communicate to them the reason or reasons the change needs to occur. "The 'why' needs to include specific data that staff and physicians can identify with," says Ms. Grae. This could involve showing data on infection rates and how effective the new cleaner is at killing the bacteria that cause infections.

Getting support from leadership. "The reason we succeeded is because we had the support from leadership," Ms. Hotchkiss says. This includes not only the hospital's CNO, but also leaders at the director level in environmental services as well as charge nurses, she explains. "It's about the message and who it comes from."

Involving multiple departments. Making such a change requires cross-department teamwork, as evidenced by how closely Ms. Grae from infection control and Ms. Hotchkiss from environmental services worked together to make this change possible. "Don't leave it up to one department," Ms. Grae urges.

In the end, one month after the implementation of the new cleaner, the hospital was already seeing results, Ms. Grae says. Eventually, the entire bundled approach led to a 23 percent reduction in C. diff infection rates at the hospital.

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