Methodist Le Bonheur Healthcare
Lessons from COVID-19: Practices to Prevent Healthcare-Associated Infections
Methodist Le Bonheur Healthcare, like many other hospitals and health systems around the world, has faced unprecedented challenges throughout the past year. Despite those challenges, Methodist Le Bonheur Healthcare and its dedicated team members have continuously risen to the call to help meet the health needs of their community, and guide them safely through the COVID-19 pandemic.
Despite the Methodist Le Bonheur Healthcare team spending a majority of their time and efforts addressing the more obvious needs of the global COVID-19 pandemic, testing, caring for patients, and eventually vaccinations; they also continued efforts to improve the safety of patients in other areas as well. Methodist Le Bonheur Healthcare implemented a number of innovative practices to address infection prevention and Healthcare-Associated Infection (HAI) risks during the COVID-19 pandemic.
Successes and Innovative Practices
The following are successes and innovative practices implemented by Methodist Le Bonheur Healthcare to address infection prevention and HAI risks during the COVID-19 pandemic.
- Activated Incident Command Center, roles assigned and daily meetings to address immediate safety issues.
- Provided daily dashboard to include: US, state, and local county COVID numbers, rapid medical screening related to COVID; Emergency Department (ED) maximum hold times; average ED hold times; number of COVID positive patients in house daily; number of new COVID positive admissions; Personal Protective Equipment (PPE) days on hand; number of pending COVID tests; average lab turn-around time (TAT) for COVID-19 testing and 30 day TAT for COVID testing; available Intensive Care Unit (ICU) vs. med-surgical beds at each hospital; daily blood supply status; daily available ventilators; and acute weekly trend snapshot.
- Emergency response plan includes hospitals, physician offices and ambulatory care sites.
- Monitored critical levels of supplies and predict need through expected surges. This included securing additional Hepa-filter machines and ventilators.
- Security of PPE, including all off-sites.
- Explored alternate PPE (KN95 quantitative testing) & alternate suppliers (MLH associates, furniture store) of critical PPE; Quantitative testing done on KN95 and other non-standard N95 masks to assess quality of mask filtration to ensure associate safety.
- Updated contracts and contingency plans that impact COVID-19 in terms of care/supplies.
- Evaluated waste management contracts.
- Collaborated routinely with local authorities and local COVID-19 response plan. Reviewed and updated community coordination plans and routine meetings with local officials including health department, mayors, and representative from each of the local hospitals.
- Daily call with executive leadership, CEOs and surgeons to coordinate reopening challenges including surgery procedures, on time case start and plans to decrease ED hold times.
- Provided IP coverage 24/7 during the first weeks of COVID-19 pandemic to provide just in time coaching to HCW caring for COVID patients and suspects.
- Used a resource called COVID hotline for patients (to support increased ED call volume) and associates who have questions about COVID.
- In-person meetings throughout system changed to online meetings when social distancing not possible based on space.
- Developed contingency plans for increase in morgue patients.
- Developed alternate care site identified by emergency management officials.
- Planned for influx of patients/surge capacity including all off-sites resulted in stopping elective surgical procedures during surge.
- Developed a staffing contingency plan for shortages. This included “skilling up” for HCW who could be reassigned to the bedside.
- Modeled and respond to financial impacts of pandemic.
- Developed marketing strategies and system communication for pandemic response including CEO daily communications, virtual town halls, and media briefings.
- Managed testing platforms and matching to reagents. Increased lab testing platforms to increase COVID test turn around times.
- Provided a program to administer convalescent plasma.
- Performed tabletop and walk through drills prior to first COVID-19 patient admission to our hospital systems. Template created for drill that involved different department’s leaders who described how their process changed to care for COVID patients or suspects. For instance, radiology used one person instead of two people to the bedside to perform chest x-ray.
- Tested ALL patients that become inpatients or have procedures in our hospitals; ensuring that “asymptomatic” tests are separated from “symptomatic” tests.
- Rolled out COVID vaccination program for HCW and community including daily calls in the beginning to ensure compliance with no waste and availability of the vaccine to the appropriate group.
- Implemented a COVID-19 cohort unit process for COVID-19 patient care. This unit included hot, warm and cold zone. N95 required for hot zone (patient room) and warm zone. The warm zone included any area immediately outside of the hot zone which might include an anteroom and when anterooms are not available it would include common space like nursing station. Cold zones require facemasks (instead of N95). Cold rooms are defined as adjacent to the warm zones like break rooms or offices.
- Minimized building entry options to hospitals and implemented kiosk COVID-19 screening at hospital entrances with one person to assist patients.
- Electronic flags to indicate COVID positive patient any time a caregiver opens the medical record.
- A first positive COVID-19 lab result electronically triggers an auto orders for COVID isolation with instruction.
- Facemask required for ALL who enter the hospital by vendors, HCW, visitors, patients.
- Facemask and eye protection required for all HCW when patient facing. Facemask required on MLH campus including walking to and from car.
- Elevators limited to number of people that supports social distancing. Number of people on elevator determined by size (2-4). Signs used and floor marked.
- All admitted patients tested for COVID-19 and wear facemask when HCW enters room until negative COVID-19 test result.
- Visitors for patients not allowed eating in patient room to decrease risks of COVID exposure of asymptomatic patients. Signage provided.
- Multiple COVID-19 signs developed including instruction for COVID-19 isolation precaution, screening, limited visitation, visitors and mask requirements while visiting in the patient room, after hours hospital entrance, and COVID-19 testing drive through directions regarding the screening.
- Cafeteria workers do not enter patient room with COVID-19 positive or suspect patient.
- Decreased hospital traffic with limiting visitors, vendors, students to reduce transmission risks. When students allowed back, COVID-19 testing required prior to hospital rotation.
- Provided Home Health service for COVID positive patients to decrease exposure in clinics.
- Allowed non-critical associates to work from home to decrease transmission risks among associates.
- Redesigned of workspaces to promote social distancing including spacing out computers and adding Plexiglas in public spaces.
- Launched telehealth visits across the physician enterprise and within hospitals to prevent exposure risk to HCW and patients.
- Implemented of the virtual clinic for positive COVID-19 patients to decrease exposure risks
- Implemented of the dedicated COVID-19 live clinic for post hospital discharge patients to minimize exposure to other patients in our outpatient clinics.
- Implemented Provider COVID Home visit and remote monitoring programs to decrease exposure risks.
- Developed Monoclonal Antibody Infusion Centers to relieve ED pressure and decrease risks of COVID transmission. One center was an Outpatient Clinic (OP)clinic and another was a closed unit in a hospital.
- Arranged “drive through” COVID Medical Screening Exams (MSEs) for screening and/or testing to keep massive influx of patients who are not significantly ill out of the EDs.
- IV pumps positioned outside the patient door to decrease exposure risks.
- HCW breaks staggered to reduce COVID-19 transmission risks.
- Used of iPad and FaceTime to connect patients to friends and family.
- Lessons learned included minimizing caregivers in COVID-19 rooms could have an adverse impact for patients. Initial plan included that EVS and nursing assistants not entering COVID cohort units. Some of the key duties of nursing assistant included Q24H replacement of suction yankauer, piston syringes, suction tubing and CHG skin treatments. Nurses could not keep up with extra work of EVS and assistant duties to meet patient demands. This resulted in careful evaluation of reassigning patient care duties to minimize number of HCW entering a COVID-19 patient or suspect room.
- During gown shortage, CDC guidelines for supply crisis implemented to reuse gowns on positive COVID patients. This resulted in increased MRSA transmission among COVID patients. This practice revised to change gowns between every patient when the national supply shortage was resolved.
- In some cases, limiting the patient caregivers had an unexpected outcome and keeping the discipline in the care of the COVID patient was the safest plan.
- Lessons learned also included the importance for assessing environment of care when routinely using portableHepa-filters in patient room due to potential increase of moisture. Close attention to new soiling of ceiling tiles.