Each month, "secret shoppers" do direct observation on the units to assess issues regarding hand hygiene.
"What we check for is hand hygiene upon entering the room and upon leaving the room," Kimber says.
To increase patients' sense of safety, Kimber says she has reinforced hand hygiene practices with clinicians so that even if nurses or physicians have just cleaned their hands with alcohol foam or gel after exiting a room, they need to reapply it if they are going directly into a new room, even if they have not touched anything between rooms.
In addition, Stillwater Medical Center is using a bleach-based product to clean all rooms and equipment after a patient is discharged.
"We used to only [use bleach] on positive C. diff rooms," Kimber explains. "Now we use it on all rooms because there are so many people who are carriers and not showing signs [of infection] until after they've been discharged."
Kimber also educates environmental services staff on the "why" behind cleaning techniques.
"What we honed-in on is the actual cleaning of the area—friction and leaving the products on for the allotted time to disrupt the replication of cells and bacteria," she says. "We've done a ton of education on how to clean, when to clean, and why to clean."
While the campaign took place over a year, Kimber says it was the addition of pulsed xenon ultra-violet robots that drove C. diff rates down to zero.
"What we saw with our use of the UV robots, which we started in October 2017, was that for the last quarter of the year, our C. diff hospital onset cases have been zero," she says. "I've been an infection control nurse for almost 18 years and I'd never seen a drop as dramatically as I had in C. diff after implementation of the UV robots."
While the robots are not cheap, Kimber estimates that each machine costs about $100,000. Stillwater purchased six robots.
"You always worry about surgical-site infections, and you always worry about those infections that patients get in the hospital such as C. diff, MRSA, CRE, and VRE," she says. "By national standards one C. diff infection is about $30,000 when you look at morbidity and length of stay. For surgical-site infection, if it's a hip or a knee, you're getting into the hundreds of thousands. So, for example, with surgical-site infections if you could just save one surgical-site infection—say a hip or a knee—you've already saved $100,000, so your ROI will be pretty quick in knocking your infection rates down."
Kimber says she encourages infection control practitioners to talk with their colleagues about effective solutions for decreasing infections—whether it's using education, technology, or something else.
"I recommend people do their own research and find out what's best for their facility and what their actual needs are," she says. "Infection control nurses have a pretty tight network, so talk to your colleagues and see what they're doing in their hospitals. Talk to the ones that are the same size as you and bigger than you and see how you can glean information from that."
Kimber says, "There were tons of things that went into [reducing hospital onset infections]. Having that rate down to zero for three months has been a huge accomplishment."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.