ISR 82 - Implementing an Innovative Tool for Rounding in Locations with High Level Disinfection

Background: Rounding in locations where high-level disinfection and sterilization (HLDs) occurs is critical for Infection Preventionists (IPs) to ensure patient safety and regulatory compliance. These locations have unique challenges requiring a specialized approach to rounding. We sought to optimize the rounding process to increase efficiency, remove barriers, and standardize communication of findings to stakeholders.

Methods: Improvement methodology, using Plan Do Study Act (PDSA) cycles was applied over 20 months for iterative optimization. The implementation team reviewed questions, built the data collection tool, and tested an automatic email notification system. Feedback from users and stakeholders was applied to the next cycle. Means, percent change, and unpaired t-tests were used to analyze the results to inform the next PDSA cycle.

Results: Two PDSA cycles and 22 rounds were completed. Cycle 1 contained 67 questions, 96 total findings, and had a mean time of 98.4 minutes. Cycle 2 contained 64 questions, 56 total findings, had a mean time of 93.1 minutes resulting in a 5.5% decrease (p=0.91) in IPs time and 52% decrease (p=0.42) in findings. Stakeholders received findings automatically 77.2% of the time during both cycles. Feedback from cycle 1 informed changes to the rounding tool: reordering questions to match the HLDs process flow, addition of more picture fields, and addition of standardized dust questions. The addition of standardized dust questions showed an opportunity for improved cleanliness during cycle 2, with locations free of dust 44.3% of the time.

Conclusions: Using improvement tools, such as PDSA cycles, are an effective method for transforming workflows and optimizing the IPs experience of HLDs rounding. Through use of PDSA cycles, we were able to measure outcomes and adapt the tool to reduce effort and meet the needs of IPs and stakeholders. This approach provides an avenue to streamline IPs processes and drive change through automated communication mechanisms.