Decontamination Safety Programme Education can we make a Difference? RCN,PgDip IPC,MSc MDD Lead Auditor

Irish Tradition

Decontamination Safety Programme Aim Minimise the risk of device related Healthcare Associated Infection in Primary and Acute Care by improving reliability in the management and decontamination of reusable invasive medical devices (RIMD). Reliability Theories, minimise variation in practice , reduce likelihood of error http://www.hse.ie/eng/about/Who/qualityandpatient safety/Medical Devices/decontamination/

Context 51 hospitals – 7 Hospital Groups 300k surgical procedures Elective Procedures ↑ 3.6% (2017) ↑75% from 2007 200k endoscopy procedures Colonoscopy 2nd most common procedure across Europe – Ireland / UK/ Malta 14/ 1000 Colorectal cancer is 2nd most common cause of cancer death in Ireland.

Context 673 public acute hospitals 2.7 million surgical procedures Elective surgery ↑ 4.4% /year Most common elective surgery – cataracts and malignant skin disease Colonoscopies 10/1000 Highest coeliac disease rate in the world Australian Institute of Health and Welfare Canberra

Key Drivers for Education Development Pressure on Turnaround Times Outbreaks relate to equipment, process, practice and device design. Training- absence of recognised academic training for technicians. Complex Device Design More Complex Procedures Doing more with less Unique Technical Skills

Key Findings and Recommendations HSE Service Review 2015 Over reliance on Manufacturer Training HSE

HIQA-Regulator Report 2016 Key Findings lack of dedicated endoscopy decontamination technicians . Recommendations Trained dedicated staff should be assigned to decontamination duties. HIQA commence thematic review of Decontamination Services in Acute Hospitals / August 2018 Education and training high on agenda

Investing in Education-Our Journey Curriculum Development What matters to the patient? Environment, Personnel, Equipment is safe for re use – Microbiology Theory and Practice – Module 1 What matters to staff? How do I reliably and safely reprocess an endoscope from manual clean to storage- Theory and Frontline Practical Skills – Module 2 What matters to the organisation? Process reliability, Validation, Water Quality, environmental monitoring , facility design – Module 3

Other Factors Considered Facility – Design – Collaboration Time constraints – Frontline challenges Learning Mode Online with 4 days contact. Tutors Cost- Funding -Target date Outcomes Staff: Academic Recognition ,Progression Quality Improvement Project in the Workplace -Conference Presentation Peer Recognition – Organisation Compliance with best practice- consistency What are the outcomes for

Project Examples

Decontamination Education Evaluation Methods Kirkpatrick 5 tier model of education evaluation Kirkpatrick (2016)

Student Evaluation Kirkpatrick’s Model : Satisfaction, Learning and Impact on learner Questionnaire- 16 question using 5 point Likert scale. Space to include free text comments on the questionnaire- . Questionnaire completed 2015, 2016, 2017 Response rate 52% (Sandelowski, 2004)

Student Evaluation

Are We Making A Difference in Practice or Ticking the Box? http://www.ct.gov/ctdn/lib/ctdn/ttt_14_m5_handouts2.pdf Kirkpatrick's 4th Level of Training Evaluation

Evaluation of Managers Perception Questionnaire- 5 point Likert Scale Questions n=8. Space to include free text comments Qualitative thematic analysis used to explore free text comments. Questionnaire completed April 2018 Response rate 48% (Sandelowski, 2004)

Evaluation of Managers Perception re Impact on Service

Thematic Analysis of Managers Comments Greater Engagement Changes in the attitude to work and ability to trouble shoot Tangible -Taking ownership of new tasks , Environmental Monitoring , Audit etc More proactive in the implementation of quality initiatives Improved compliance to standards in the department Greater awareness of their role in driving patient safety.

Thematic Analysis of Managers Comments Confidence Great knowledge and pride in work and confidence in decision making using knowledge to participate in conversations in relation to best practice Willingness to challenge poor practice Profile Willingness to progress to Degree Level/ other PD opportunities Raised profile and educational needs of department. Greater financial support from SMT.

Summary of Outcomes 220 Decontamination Students- 70% from HSE 30% Private Hospitals and Industry – Accessibility Standardised Learning 20% Progression to Degree Endoscopy, RIMD and US Probes Primary Care Frontline Engagement Empowering FLO –

Go Raibh Maith Agat !