By Michele Rowland

Although modest in size, Brattleboro Memorial Hospital has always endeavored to keep pace with recent research findings, implement evidence-based treatment interventions and improve the scope and complexity of services offered to our patients. Two programs recently implemented at BMH best capture these efforts: the Multi-drug Resistant Organisms Prevention Program and the Sepsis Prevention Program.

Michele Rowland

Multi-drug resistant organisms (MDROs) such as MRSA, VRE and C difficile have been the focus of media attention for some time due to the grave risk these infectious agents pose to our health. Medical advances have brought lifesaving care to us, yet many of those advances come with a risk. Many infection causing organisms have, over the years, developed resistance to the drugs that were once effective at limiting them due to frequent and repeated use of known antibiotics. Recently scientists have established several interventions that are successful in minimizing transmission of these devastating and potentially deadly drug resistant organisms. The interventions include: Antibiotic Stewardship—careful use of the appropriate antibiotics only when a documented infection is present, increased surveillance and awareness of infection risk by all members of the healthcare team, adoption of Standard Contact Precautions such as hand washing with soap and water or alcohol based hand wash after each patient contact, decolonization of patients who may be unaware they are “carriers” of the infection, and increased patient and staff education on infection risks and appropriate antibiotic use.

Last year the Centers for Disease Control in Atlanta, Georgia challenged healthcare institutions across the state of Vermont to address the issue of MDROs. With the increasing array of services available to patients in ambulatory settings, the decreasing length of stay for patients in acute care hospitals and the frequent transition of patients between healthcare venues, the importance of collaboration among providers has never been more critical.

In response to the CDC initiative, the Brattleboro Cluster was formed. This group of health and residential care providers is composed of Pine Heights, Thompson House, Vernon Green, Grace Cottage Hospital, Holton Home, Hilltop House, Brattleboro Retreat and West River Valley Assisted Living. Led by BMH’s Director of Risk Management, Safety and Credentialing, Jan Puchalski, the group met for several months with the goal of improving health outcomes for our patients. During those initial meetings, members shared policy and procedures for patients with known and suspected infections, best practices for care, and streamlined communications tools to aid in the transfer of essential information as patients move along the continuum of care. With standardized protocols and practices in place, the facilities are reporting very positive results.

Sepsis is a life-threatening illness in which the body has a severe response to bacteria or other infectious organisms. The response is not caused by the organisms themselves but by the chemicals the body releases in response to the infection, generating a system wide inflammation that the body tries to rid itself of. This process can cause the formation of microscopic blood clots that prevent oxygen from reaching internal organs and cause a sudden drop in blood pressure. Severe sepsis has an overall mortality rate of 29%—much higher than the rates for heart attack or stroke. Sepsis kills more than 200,000 every year in the United States.

Based on guidelines developed by the Society of Critical Care Medicine, an international body devoted to excellence in the practice of critical care, the goal of BMH’s Sepsis Prevention Program is to identify patients at risk for developing sepsis and to provide early, aggressive treatment.

The BMH guidelines begin in the Emergency Department, where nurses assess a patient’s risk for developing sepsis using a simple, easy to use evaluation form. Based on scoring on the form and the results of blood testing, ED staff can immediately initiate sepsis prevention treatment, including fluid resuscitation to keep blood volumes at appropriate levels and administration of appropriate antibiotics.

This program was developed through the collaboration of a cadre of physicians and nurses in our ED, Laboratory and Hospitalist programs. The group was led by Laurie Kuralt, Nurse Manager Special Care Unit and Respiratory Services. While still in its early stages, we have already seen positive results and look forward to continuing our focus on providing effective and efficient quality patient care.

Michele Rowland, RN, LICSW is the Executive Director of Quality, Utilization and Care Management at Brattleboro Memorial Hospital.