Infection Control The overall, long-term objectives in this area are to reduce the level of nosocomial infections at Pirogov and to serve as a model partnership and site for the development of hospital infection control techniques for the Ministry of Health. Methods to achieve this overall goal:

• Introduce and reinforce techniques to protect staff and patients from communicable diseases.
• Educate staff on tuberculosis and hepatitis risks, modes of transmission, and worldwide occurrence.
• Conduct hospital surveys and implement practice alterations to reduce nosocomial infections.
• Introduce procedures for wound and skin observation, documentation and care.
• Provide education on the rational use of antibiotics and pre-operative and intra-operative techniques to reduce surgical infections.
• Track nosocomial infections and infectious diseases in defined populations.

Nursing Education and Management

• Foster a model of professional collaborative practice for all members of the health care team focusing on evaluating nursing care delivery models and logistics of patient flow.
• Promote the development of a patient-centered approach to care introducing concepts and advantages of patient teaching.
• Introduce and advance the concepts of nursing managerial roles and professional development.
• Engage physicians in the elevation of nursing practice and nursing education.
• Develop a certificate program in nursing education to raise the professional level of nursing staff at Pirogov and in Moscow.
• Establish a "train-the-trainer" program for nursing including didactic and clinical experience. Provide modular educational material and supplies to support the nursing trainers.
• Provide supplies and translated resource materials in all focus areas of nursing.
• Cooperatively plan and host annual international nursing conferences focusing on clinical topics relevant to the partnership.

Hospital Administration and Finance

• Provide education on US, Russian, and international health care financing systems by comparing BWH and Pirogov operating systems, vendor negotiations, allocation for wages, and infrastructure support.
• Introduce the accounting management staff to the components of financial planning including accounts payable services and credit and debit systems.
• Introduce new models of pharmacy operations and narcotic control.

Surgery

• Improve and enhance care given in the operating room at Pirogov to reduce complications and length of stay.
• Promote professional relationships to improve patient procedures.
• Improve wound infection and associated morbidity rates.
• Improve the utilization of time and resources while enhancing patient care by re-evaluating patient flow from Emergency Department admission through the Operating Room to the Intensive Care Unit.
• Re-evaluate roles and responsibilities of OR team members. Help the NIS partners establish committees at Pirogov to improve Operating Room and Emergency Room function, quality markers, and patient flow.

• On February 9, the partners celebrated the signing of the Memorandum of Understanding between Brigham and Women's Hospital on the US side, and City Clinical Hospital No. 1 in the Name of Pirogov in Russia.
• The NIS partners hosted "Contemporary Problems in Surgery" conference for over 600 NIS clinicians. Participants in this conference included the US ambassador to Russia and the mayor of Moscow.
• The partners at Brigham and Women's Hospital hosted two Special American Business Internship Training (SABIT) fellows, specializing in anesthesia and orthopedics.

• The Pirogov partners hosted a conference on "Nosocomial Infections: Prevention and Control" for 250 NIS nurses. This conference increased awareness of the integral role of nurses in prevention and control of nosocomial infections. The conference also included hands-on demonstrations and Pirogov clinicians received props and teaching tools for repeat presentations.

• A team of US physicians and infection control practitioners from AIHA's Infection Control Task Force conducted an intensive infection control survey at Pirogov. The team used a model survey protocol developed for the NIS by the Task Force, based on the International Hospital Infection Prevention and Quality Assessment Program (INQUAL). At the conclusion of the survey, a detailed, 70-item report with recommendations was submitted for use as an assessment and improvement tool. The recommendations addressed all aspects of a hospital-based infection control program including organizational issues, surveillance activities, policies and procedures, facilities, patient care practices, environmental cleaning and waste.
• Pirogov hosted a conference entitled "Professional Issues in Nursing" for over 200 clinicians from throughout the NIS. This conference emphasized the need to increase the clinical, professional and management profile of nurses.

• The NIS Partners hosted a conference entitled "Interventions in Trauma," to over 200 clinicians from throughout the NIS. At this conference chief nurses from Pirogov gave comprehensive patient care presentations.
• Ongoing cooperative partnership activities related to surgery and infection control were instrumental in the renovation of the Trauma Building (#15) and an Operating Room at Pirogov.

• The partners held their first teleconference broadcasting from Boston to Moscow on the topic of "Nursing Management." The conference consisted of an interactive discussion of progress, tools and barriers in this area.
• The partners presented two seminars entitled "Financing Health Care in the US and Russia" and "Comparative Study of Health Care Systems in the US, Western Europe, NIS and Japan" to an audience of 100 clinicians and students at Pirogov.
• The partners conducted a teleconference on the "Care of the Patient with an Acute Myocardial Infarction," using a case study review and comparison.
• Pirogov hosted a conference entitled "Emergency Care of the Ill and Injured Patient" for 200 clinicians from the Moscow area. The conference included an Advanced Cardiac Life Support component.

• The partners held a teleconference to discuss care of the rheumatology patient.
• The partners presented two case studies, via teleconference, focusing on trauma resulting from penetrating gunshot wounds and motor vehicle accidents.
  

Infection Control

• In 1995, the Russian Ministry of Health selected Pirogov Hospital as a model site for the development of hospital infection control techniques.
• As a result of partnership activities, the partners re-evaluated practices and attitudes about infection control. Overall, their findings were that while gaps remained, many of the practitioners at Pirogov have changed their practice to reduce infection within the confines of the health care environment in Russia. Within Pirogov, over 20 different infection control practices have changed as a direct result of partnership endeavors in this field. These changes include the introduction of new protocols for the use of antimicrobial agents, particularly the administration of prophylactic antibiotics to all perioperative patients; more effective management of patients on respirators (new sterilization techniques); new patient care practices and hand-washing protocols; safer procedures for urine collection; larger roles for nurses in infection control; the implementation of a nosocomial infection surveillance report; and the implementation of an infectious disease history form.
• New infection control protocols and procedures at Pirogov have led to:
  a) A dramatic decline in post-surgical infections in the surgical unit of Building #15;
  b) A lower rate of nosocomial infections overall. For such infections as pneumonia, purulent meningitis and wound infections, this means a per-patient savings of $1000, $1400 and $800 respectively;
  c) A reduction in average length of stay, especially in the intensive care unit. In the ICU, each one-day reduction saves $200 per patient;
  d) A slight decline in overall mortality from 4.4% in 1995 to 3.6% in 1998.
• The partners at Pirogov created a hospital epidemiologist position and established a ten-member Infection Prevention/Quality Assurance Committee. The committee works closely with the hospital epidemiologist to implement a hospital-wide infection control program. The committee made recommendations that led to significant facility enhancements in the operating room including ultraviolet lights, new floors and secured doors. In addition, a nurse was identified as assistant epidemiologist.
• The Partners devised a Post-Surgical Wound Classification Guide for the Pirogov Infection Control/Quality Assurance Committee. This guide is used to classify wounds, wound infections, and subsequent illnesses.

Surgery

• In order to improve utilization of time and resources while enhancing patient care, the NIS partners overhauled their Emergency Department, incorporating concepts of triage, acute vs. non-acute care, and patient intake and processing from the BWH system. They reengineered patient flow from Emergency Department admission through the Operating Room to the Intensive Care Unit.
• The Pirogov partners have introduced pre-operative patient examinations, which has resulted in a shorter length of stay for surgical patients - from 15 days in 1996 to 12.4 days in 1998.
• The NIS partners established committees at Pirogov to improve Operating Room and Emergency Room function, quality markers and patient flow.

Nursing Education and Management

• Building on partnership efforts to advance the concepts of nursing managerial roles and professional development, the Pirogov partners created the position of Chief Nurse. They also appointed a deputy chief physician in charge of paramedical personnel management and a nurse responsible for educational issues.
• As a result of partnership efforts to re-evaluate nursing care delivery models at Pirogov and to promote the development of a patient-centered approach to care, the Pirogov partners have noted that there are improvements in certain medical procedures, and patients rights are more consistently observed.

Hospital Administration and Finance

• As a result of partnership efforts to introduce Pirogov's accounting staff to the components of financial planning, the NIS partners have developed new approaches to financial accounting which have been approved by the Moscow Health Care Committee.
• The Pirogov partners now conduct product selection and purchasing on a competitive basis, monitored by the relevant committees.