Pfc. Logan Pickell (left), a licensed practical nurse on the Multi-Service Unit at Bassett Army Community Hospital, conducts an environmental cleaning tracer with Rebekah Lail (right), the infection prevention manager.

Infection Prevention

Meet an Every Day MHS Infection Control Champion
By DoD Patient Safety Program

The Patient Safety Champion Certificate of Recognition is a peer-to-peer initiative to recognize patient safety champions throughout the Military Health System. Ms. Rebekah Lail, infection prevention manager at Medical Department Activity – Alaska at Fort Wainwright, Alaska, was one of the first recipients after the DoD Patient Safety Program launched the initiative in March 2018.

Lail is helping to lead the staff at MEDDAC-AK, which includes Bassett Army Community Hospital and three outlying clinics, as they are focused on six key areas this year: instrument pre-cleaning, high-level disinfection, hand hygiene, bloodborne pathogen exposures, isolation precautions and sterilization. To track progress against these goal areas, they are using the Joint Commission 
tracer methodology, which follows the experience of care, treatment or service for patients through an organization's entire health care delivery process. Tracers are a cornerstone to Joint Commission accreditation.

"The tracers are designed to look at multiple elements of performance. Five of our six goals are tracked using tracers. For these goals, the data can be plugged into the system and produce compliance reports," Lail explains. "I can look each month and see where I need to place my focus. The tracer system makes it easier to drill down and find compliance issues."

Each day, Lail ensures daily priorities support the facility's long-term goals, because many patient safety issues can come from something not being properly cleaned and sterilized.

"Every day I review the patients on the floor to see if we have patients in isolation or with a central line or surgical site," Lail said. "We're a small military treatment facility and don't have a lot of infections, but our goal is to keep our rate at zero. We haven't had any catheter-associated urinary tract infections in about 10 years and central line-associated blood stream infections in more than five years."

More recently, the Bassett ACH staff have been successful in eliminating Clostridium difficile infections.

The sterile processing department is one part of Bassett’s effective infection prevention system. They are responsible for properly cleaning and sterilizing tools and equipment according to manufacturer recommendations. Depending on what is being cleaned, the manufacturer recommendations can vary, adding a layer of complexity to the cleaning and sterilizing processes, Lail said.

Infection prevention requires a whole team effort beyond a highly reliable sterile processing department. Lail attributes coordination through inpatient staff in the Multi-Service Unit and Maternal Newborn Unit with playing a big role in keeping the rate of CAUTI so low. Most catheters do not stay in for more than two days; they remove them as soon as possible. Additionally, while the MTF doesn't have a lot of central lines, they carefully follow procedural checklists to keep CLABSI infections down.

To further support infection prevention in other areas of the facility, Lail conducts weekly safety environment of care site visits. Every department gets looked at twice a year.

During her visits, Lail looks at whether the area and equipment are cleaned properly, and checks in with staff that they have the resources they need to do their jobs safely to prevent infection. For example, ensuring staff are wiping down equipment, such as endoscopes, at the point-of-use and transporting this used equipment properly to prevent contamination of other clean and sterile equipment are processes she is confirming are in place.

New staff are taught basic infection prevention skills during newcomer orientation to begin implementing right away. To reinforce this knowledge, inpatient and outpatient staff participate in an annual skills fair. The last skills fair focused on CLABSI prevention through proper central line care and maintenance, instrument pre-cleaning for infection prevention.

"I believe the more information and education we can provide staff about why we do certain things, it helps staff to make conscious decisions to do the right thing every time," Lail said. "We've noticed when we help staff understand the 'why' behind a process, we have better compliance with our policies and procedures."

On a more regular basis, Bassett leaders conduct daily huddles, leadership rounds and monthly control meetings. During the daily morning nursing reports and daily quality and safety huddles, Lail incorporates components of TeamSTEPPS

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based teamwork system designed to improve the quality, safety and efficiency of healthcare. 

TeamSTEPPS consists of a collection of instructions, materials and tools to help drive a successful teamwork initiative from the initial planning to implementation through to sustainment. The system is designed to improve patient safety using a three-phase approach: Phase I Assessment: Facility determines organizational readiness; Phase II Planning, Training & Implementation: Facility “decides what to do” and “makes it happen;” and Phase III Sustainment: Facility spreads the improvements in teamwork performance, clinical processes and outcomes resulting from the TeamSTEPPS initiative, such as closed-loop communication. She also encourages staff to feel comfortable speaking up in the interest of patient safety.

Monthly patient safety and infection control meetings provide Lail an opportunity to report on improvement projects. She also networks and collaborates regularly with other Army facilities to share lessons learned.

While there isn't one thing the staff attribute to keeping the infection rates so low, Lail believes it's the multiple things done to educate and make sure staff are following all infection prevention policies and evidence-based guidelines that makes the difference.

In recognition of these safety initiatives, Lail received the Patient Safety Champion Certificate of Recognition this year. Capt. Rory Walton, an operating room nurse at Bassett ACH, nominated Ms. Lail for the award because of the partnership she has established with MEDDAC-AK staff.

"Upon her arrival, Ms. Lail made collaborative and data-based initiatives to move our organization's patient safety efforts forward. She is devoted to developing effective solutions for both our clinicians and patients," Walton said. "Her tenacious spirit and upbeat attitude have brought lasting change to each department she engages with."

Walton attributes Ms. Lail for being a key player in advancing the facility into a high reliability organization.

"We could not be more thankful for the helpful ways she has challenged us to grow, collaborate, and lead the nation in patient care," Walton said.

Source: health.mil

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