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Reduced isolation room turnover time using Lean methodology

Published online by Cambridge University Press:  26 July 2019

Andrea L. Ankrum ,
Smriti Neogi ,
Molynda A. Morckel ,
Adam W. Wilhite ,
Zhaoyan Li  and
Joshua K. Schaffzin
Andrea L. Ankrum*
Affiliation:
Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Smriti Neogi
Affiliation:
James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Molynda A. Morckel
Affiliation:
James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Adam W. Wilhite
Affiliation:
Crothall Healthcare, Wayne, Pennsylvania
Zhaoyan Li
Affiliation:
Crothall Healthcare, Wayne, Pennsylvania
Joshua K. Schaffzin
Affiliation:
Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
*
Author for correspondence: Andrea Ankrum, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 5019, Cincinnati, OH 45229. Email: [email protected]
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Abstract

Objective:

To prevent environmental transmission of pathogens, hospital rooms housing patients on transmission-based precautions are cleaned extensively and disinfected with ultraviolet (UV) light. To do so consistently requires time and coordination, and these procedures must avoid patient flow delays and associated safety risks. We sought to improve room turnover efficiency to allow for UV disinfection.

Design:

A 60-day quality improvement and implementation project.

Setting:

A quaternary academic pediatric referral facility.

Interventions:

A multidisciplinary healthcare team participated in a 60-day before-and-after trial that followed the Toyota Production System Lean methodology. We used value-stream mapping and manual time studies to identify areas for improvement. Areas addressed included room breakdown, room cleaning, and wait time between cleaning and disinfection. Room turnover was measured as the time in minutes from a discharged patient exiting an isolation room to UV disinfection completion. Impact was measured using postintervention manual time studies.

Results:

Median room turnover decreased from 130 minutes (range, 93–294 minutes) to 65 minutes (range, 48–95 minutes; P < .0001). Other outcomes included decreased median time between room breakdown to cleaning start time (from 10 to 3 minutes; P = .004), room cleaning complete to UV disinfection start (from 36 to 8 minutes; P < .0001), and the duration of room cleaning and curtain changing (from 57 to 37 minutes; P < .0001).

Conclusion:

We decreased room turnover time by half in 60 days by decreasing times between and during routine tasks. Utilizing Lean methodology and manual time study can help teams understand and improve hospital processes and systems.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1151 - 1156
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Sigler, V, Hensley, S. Persistence of mixed staphylococci assemblages following disinfection of hospital room surfaces. J Hosp Infect 2013;83:253–256.CrossRefGoogle ScholarPubMed
Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593–599.CrossRefGoogle ScholarPubMed
Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.CrossRefGoogle ScholarPubMed
Anderson, DJ, Chen, LF, Weber, DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection Study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805–814.CrossRefGoogle ScholarPubMed
Anderson, DJ, Gergen, MF, Smathers, E, et al. Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C–emitting device. Infect Control Hosp Epidemiol 2013;34:466–471.CrossRefGoogle ScholarPubMed
Rutala, WA, Gergen, M, Weber, DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol 2010;31:1025–1029.CrossRefGoogle ScholarPubMed
Anderson, DJ, Knelson, LP, Moehring, RW, et al. Implementation lessons learned from the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: process and perceptions of enhanced disinfection with ultraviolet disinfection devices. Infect Control Hosp Epidemiol 2018;39:157–163.CrossRefGoogle ScholarPubMed
Britto, MT, Anderson, JM, Kent, WM, et al. Cincinnati Children’s Hospital Medical Center: transforming care for children and families. Jt Comm J Qual Patient Saf 2006;32:541–548.Google ScholarPubMed
Quality improvement education: Lean home. Cincinnati Children’s Hospital Medical Center website. http://centerlink.cchmc.org/department/quality-improvement/qi-education/lean-collaborative-program/qi-education-lean-home. Published 2019. Accessed January 29, 2019.Google Scholar
Liker, JK. The Toyota Way. 14 Management Principles from the World’s Greatest Manufacturer. New York: McGraw-Hill Education, 2004.Google Scholar
Toyota production system. Toyota Motor Corporation website. https://global.toyota/en/company/vision-and-philosophy/production-system/. Published 2019. Accessed June 7, 2019.Google Scholar
Kim, CS, Spahlinger, DA, Kin, JM, Billi, JE. Lean health care: what can hospitals learn from a world-class automaker? J Hosp Med 2006;1:191–199.CrossRefGoogle ScholarPubMed
Fields, E, Neogi, S, Schoettker, PJ, Lail, J. Using Lean methodologies to streamline processing of requests for durable medical equipment and supplies for children with complex conditions. Healthc (Amst) 2018;6:245–252.CrossRefGoogle ScholarPubMed
Schaffzin, JK, Finney, D, Wilhite, A, Li, Z, Moore, R, Connelly, BL. Maximizing Efficiency in a High Occupancy Setting to Utilize Ultraviolet Disinfection for Isolation Rooms. Portland, OR: Society for Healthcare Epidemiologists of America; 2018.Google Scholar
Going Lean in Health Care. IHI Innovation Series white paper. Improvement for Healthcare Improvement website. http://www.ihi.org/resources/Pages/IHIWhitePapers/GoingLeaninHealthCare.aspx. Published 2005. Accessed July 3, 2019.Google Scholar
Anderson, DJ, Moehring, RW, Weber, DJ, et al. Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster randomised controlled trial with crossover design (BETR Disinfection). Lancet Infect Dis 2018;18:845–853.CrossRefGoogle Scholar
Rutala, WA, Kanamori, H, Gergen, MF, et al. Enhanced disinfection leads to reduction of microbial contamination and a decrease in patient colonization and infection. Infect Control Hosp Epidemiol 2018;39:1118–1121.CrossRefGoogle Scholar
Hosein, I, Madeloso, R, Nagaratnam, W, Villamaria, F, Stock, E, Jinadatha, C. Evaluation of a pulsed-xenon ultraviolet light device for isolation room disinfection in a United Kingdom hospital. Am J Infect Control 2016;44:e157–e161.CrossRefGoogle Scholar
Spencer, M, Vignari, M, Bryce, E, Johnson, HB, Fauerbach, L, Graham, D. A model for choosing an automated ultraviolet-C disinfection system and building a case for the C-suite: two case reports. Am J Infect Control 2017;45:288–292.CrossRefGoogle Scholar
Jweinat, J, Damore, P, Morris, V, D’Aquila, R, Bacon, S, Balcezak, TJ. The safe patient flow initiative: a collaborative quality improvement journey at Yale–New Haven Hospital. Jt Comm J Qual Patient Saf 2013;39:447–459.Google ScholarPubMed
King, DL, Ben-Tovim, DI, Bassham, J. Redesigning emergency department patient flows: application of Lean Thinking to health care. Emerg Med Australas 2006;18:391–397.Google ScholarPubMed
Cima, RR, Brown, MJ, Hebl, JR, et al. Use of Lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg 2011;213:83–94.CrossRefGoogle Scholar
Improta, G, Cesarelli, M, Montuori, P, Santillo, LC, Triassi, M. Reducing the risk of healthcare-associated infections through Lean Six Sigma: the case of the medicine areas at the Federico II University Hospital in Naples (Italy). J Eval Clin Pract 2018;24:338–346.CrossRefGoogle Scholar
D’Andreamatteo, A, Ianni, L, Lega, F, Sargiacomo, M. Lean in health care: a comprehensive review. Health Policy 2015;119:1197–1209.CrossRefGoogle Scholar
Glasgow, JM, Scott-Caziewell, JR, Kaboli, PJ. Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma. Jt Comm J Qual Patient Saf 2010;36:533–540.Google ScholarPubMed
Kaplan, HC, Brady, PW, Dritz, MC, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010;88:500–559.CrossRefGoogle ScholarPubMed
Chen, LF, Vander Weg, MW, Hofmann, DA and Reisinger, HS. The Hawthorne effect in infection prevention and epidemiology. Infect Control Hosp Epidemiol 2015;36:1444–1450.CrossRefGoogle ScholarPubMed
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