Two Virginia hospitals receive first ID risk management certification

Sentara Leigh and Sentara Virginia Beach hospitals are the first two hospitals to receive the DNV Healthcare Centers for Excellence infection mitigation management certification.

DNV, a global certification organization, partnered with the hospitals to develop strategies to reduce infection and implement control measures above those required by current regulations.

In a conference call, Scott A. Miller, MD, vice president of medical affairs for Sentara Leigh Hospital, said before undertaking the process of managing infection risk (MIR), the present mindset was that nosocomial infections were a normal part of hospital admissions.

“We had kind of a wrong culture. We thought infections are part of the deal when you take care of sick patients,” Miller said. “Those of us who have been in this for a long time had grown numb to it.”

With new CMS reporting guidelines, Miller said the hospital had to find new ways of mitigating infection risk.

“We knew we were going to be looked at all the more intently. We felt like we were continually trying to do the same process better, and we weren’t finding any magic bullets,” Miller said. “I think that what happened with the DNV MIR is that it allowed us to look at things in a more systematic way.”

Peggy J. Braun, RN, BSN, MHA, CENP, vice president of patient care and nurse executive at Sentara Virginia Beach General Hospital, said the certification process united the hospital in a new way and that nonclinical staff played an important role.

“The level of attentiveness and awareness as we began this journey this really brought out a level of staff empowerment and engagement that, personally, I have not experienced before,” Braun said on the call. “The environmental staff, the maintenance staff brought up examples of how to do things better, and before some of these folks weren’t likely to speak up. Each one of us is a care provider and contributes to patient safety.”

While they followed the plan established with DNV, innovations also came from other people.

“We have a really bright maintenance fellow who partnered with the medical director and created a motion sensitive light that goes on when you enter a patient’s room to remind you to wash your hands. This was unheard of even 2 years ago,” Braun said, describing the implementation process as “exciting.”

Miller concurred.

“It was a lot of fun to do this in that we were able to engage the entire hospital in ways we hadn’t done before,” he said.

Recognizing that both the medical staff and hospital employees all had a role in patient safety was critical to the process, according to Braun and Miller.

“It was about getting back to the idea of a team,” Miller said. “In my head, there had always been the hospital employees and the medical staff, and frankly, they were held to different standards.

“We need to have absolute certainty that anyone who interacts with patients at any of our facilities has the same degree of safety, from their awareness of infection prevention techniques and vaccination status,” Miller said, noting that Sentara’s 12 hospitals employ about 4,400 people. “That is no small undertaking.”

Certification began with an application to DNV GL, which then performed pre-assessment work to identify gaps before an individualized plan was developed for each institution.

Patrick Horine, MHA, CEO of DNV Healthcare US, said the additional steps Sentara hospitals took to reach certification will position it to be more prepared for pandemics.

“Hopefully this staff is now positioned to handle anything,” Horine said. “Moving forward, should an Ebola patient enter [Sentara’s] four walls, they are going to be better prepared,” he said, and added that their training prepares them for diseases that are much more contagious.

Horine said 22 additional hospitals have begun the certification process. Two will be ready for certification by the end of the year, and Horine said the process and length of time to certify is different for each institution. Larger hospitals may take 1 to 2 years to reach certification, while a smaller organization may only take 6 months. – by Shirley Pulawski