dicon.mc.duke.edu  
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About DICON

The Duke Infection Control Outreach Network (DICON)

Introduction

During the past 20 years, community hospitals in our region and throughout the country have faced the difficult task of providing state-of-the art and safe care to patients while simultaneously meeting complex mandates and regulations imposed by agencies such as the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA). These regulatory agencies promulgated rules to ensure that hospitals have safe work environments and to optimize patient safety, but in their aggregate, regulatory requirements have overwhelmed small to medium-sized rural community hospitals with limited staff, increasingly restricted budgets, falling revenues from third party payers, and the duty to care for substantial numbers of uninsured and underinsured patients. Programs that address infection control and patient safety issues are found to be at the core of an increasing number of quality of care, safety, cost of care and regulatory imperatives - and DICON is a Duke University Medical Center (DUMC) program that strategically focuses on these areas of concern.
 
Clearly, controlling infections is a struggle for hospitals everywhere. Achieving this goal becomes more complicated each year as new technologies and procedures are creating new infection control problems. Antimicrobial resistance has increased to an alarming level and tighter budgets and staff cutbacks are making it harder for many hospitals to meet increasingly complex infection control regulations. The converging impact of these trends is particularly unfortunate and ill-timed at community hospitals, where infection control programs are usually managed by nurses with numerous additional responsibilities. DICON exists to advance efforts that improve quality of care and enhance patient safety while minimizing the costs associated with non-evidence based approaches to infection control.

Background

In 1997, the Duke Infection Control Outreach Network (DICON) was formed to address many of these issues. A collaboration between Duke and 35 community hospitals, DICON is focused on improving infection control programs by compiling data on nosocomial infections at member hospitals, identifying trends and areas for improvement, and providing ongoing education and leadership to community providers. DICON exists to help hospitals with limited resources develop state-of-the-art infection control programs - and to give institutions with more sophisticated programs access to comparative statistics to support their infection control efforts. The primary focus of DICON is to improve outcomes for patients – reducing the rate of nosocomial (healthcare-associated) infections and minimizing the costs associated with nosocomial and community-acquired infections.
 
Duke physicians and nurses specializing in infection control work with existing hospital staff to identify practices and policies that will improve patient care and/or reduce unnecessary medical supply costs, additional inpatient days, unreimbursed readmissions and related causes of patient dissatisfaction. When problems in infection control or patient safety policies or practices are identified, corrective action plans are developed that are designed to both correct the immediate problem and prevent its recurrence.
 
Using regular visits by four full-time infection control nurse practitioners, a standardized database and uniform surveillance methods designed to provide meaningful and useful local data to doctors and nurses in community hospitals, newsletters, a website, periodic symposia and educational lectures, DICON has had significant and substantial impact on reducing the risk of post-surgical, device-related, and bloodstream infections as well as helping to reduce the risk of blood and body fluid exposures for employees in DICON-affiliated hospitals.

Results

In a study of 12 hospitals who were in DICON for at least 3 years during the period from 1999-2003, the following results were reported in a article in the March 2006 issue of Infection Control and Hospital Epidemiology:
 
Trends in nosocomial infections at DICON hospitals
    • Employee exposures to blood and body fluids
DOWN 18%
    • Nosocomial infections due to methicillin-resistant Staphylococcus aureus (MRSA)
 
DOWN 22%
    • Nosocomial blood stream infections
DOWN 23%
    • Foley-associated urinary tract infections
DOWN 27%
    • Ventilator-associated pneumonias
DOWN 40%
 
 
Also during this same period, DICON had a positive role in the following areas:
    • No DICON hospital undergoing inspection by JCAHO received a Type I recommendation for its infection control program
    • All DICON hospital infection control programs inspected by JCAHO were considered “excellent” in the final JCAHO inspection report
    • Utilization of single set blood cultures and treatment of blood culture contaminants was reduced in all DICON hospitals participating in this component of the program

Network Composition and Activities

Originally developed as a collaborative network of 5 hospitals, DICON has grown to include:
    • 39 hospitals in five states
    • Small community hospitals and large regional medical centers ranging in size from 30 to 638 beds
    • 9,700 occupied beds (cumulative)
    • 45,000 employees (cumulative)

Services

The methodologies used in DICON were developed and trialed in the community environment. DICON affiliates receive the following:
 
    • ongoing infection control consultative assistance from a staff that includes 4 faculty infectious disease physician/epidemiologists, 2 infectious disease sub-specialty fellows and 5 full-time infection control practitioners
    • consultative support ranging from outbreak investigations to special projects such as programs that standardize and improve the diagnosis of bacteremia
    • an extensive program that monitors the rates of surgical site infections (SSI) - providing surgeons at affiliated hospitals with surgeon-specific, procedure-specific, risk-adjusted rates of postoperative surgical site infections
    • benchmarking reports that consist of time-trended intra- and inter-hospital infection rates (while keeping individual hospitals' information confidential and while following all current HIPAA regulations) on the employee exposure rates and nocosomial infection rates mentioned above – allowing community hospitals to benchmark reductions in nosocomial infection rates against community hospitals of similar size.
    • a monthly newsletter
    • a website containing resources and technical information for DICON hospital personnel
    • participation in an annual educational symposium

Databases

The DICON databases are a powerful tool that provides DICON hospitals with time-trended intra- and inter-hospital benchmarking data. This data is provided to hospitals in easy-to-view graphical formats that allow administrators and medical staff members to see quick snapshots of trends at their facilities. The data also shows how they compare to other DICON hospitals (e.g. while keeping individual hospitals' information confidential and following all current HIPAA regulations). – allowing their hospital to benchmark reductions in nosocomial infection rates against community hospitals of similar size.
 

Contact Information for DICON Staff Members

Deverick Anderson, MD, MPH
Assistant Professor of Medicine
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 919-681-7483
Fax: 919-681-7494
 
Grace Auten, MD
Assistant Consulting Professor
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 828-328-6100
Fax: 828-328-6795
 
Keith Kaye, MD, MPH
Associate Director, Duke Infection Control Outreach Network (DICON)
Associate Professor
Duke University Medical Center
Phone: 919-668-1720
Fax: 919-681-7494
 
Daniel J. Sexton, MD
Director, Duke Infection Control Outreach Network (DICON)
Professor of Medicine
Duke University Medical Center
Phone: 919-684-4596
Fax: 919-681-7494
 
Paul A. Thacker, II
Administrative Director
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 919-684-4560
Fax: 919-681-7494
 
Rita McCoy
Program Specialist
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 919-684-4596
Fax: 919-681-7494
 
Luke Chen, MD
Fellow, Division of Infectious Diseases
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 919-684-4596
Fax: 919-681-7494
 
Joshua Freeman, MBChB
Postdoctoral Associate
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone:  919-684-4596
Fax:  919-681-7494
 
Linda Adcock, RN, BSN, CIC
DICON Nurse Clinician
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 540-588-7337
 
Evelyn Cook, RN, CIC
DICON Nurse Clinician
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 919-943-9768
 
Susan Louis, RN, CIC
DICON Nurse Clinician
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 828-329-8941
 
Connie Clark, RN, BSN, CIC
DICON Nurse Clinician
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 252-904-8259
 
Andrea Lynn Cromer, RN, CIC
DICON Nurse Clinician
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 864-804-9241
 
Yong Choi, RN
Clinical Research Coordinator
Duke Infection Control Outreach Network (DICON)
Duke University Medical Center
Phone: 919-668-3833
 
Barry Shelton
IT Specialist for DICON
President
Malachite Corporation
Phone: 919-471-2609
 
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