Improving the Culture of Hand Hygiene Deborah Scott RN, Infection Prevention QI Specialist

Improving the Culture of Hand Hygiene Using Teamwork and Transparency with Leadership Engagement

”Leadership plays a critical role in hospital infection prevention and control programs” — Infection Control and Hospital Epidemiology Effective Hand Hygiene Saves Lives

Effective Hand Hygiene Saves Lives Successful hospitals: Cultivate a culture of clinical excellence and effectively communicate it to staff Focus on overcoming barriers and deal directly with resistant staff or process issues Inspire their employees Saint, et al. (2010)

Conclusion Leadership plays a key role in infection prevention. The challenging process of translating the findings of infection prevention research into practice can be eased by leaders who heed the advice and experiences of their colleagues Reference: Saint SS, Kowalski CP, Banaszak ‐ Holl J, Forman J, Damschroder L and Krein SL. The Importance of Leadership in Preventing Healthcare ‐ Associated Infection: Results of a Multisite Qualitative Study. Infect Control Hosp Epidemiol. 2010;31:

My Healthy Arkansas Initiative in Citywide Hand Hygiene Initiative Triggers 25% Drop in Community Infection Rate (Jonesboro’s My Healthy Arkansas Initiative)

Effective Hand Hygiene Saves Lives Healthcare workers’ unclean hands are the #1 source of germ transmission and healthcare- associated infections 2 million people in the U.S. contract a HAI each year resulting in 99,000 deaths Preventable infections cause more deaths than AIDS, breast cancer, and auto accidents combined TN: 6 out of every 100 patients are colonized or infected with MRSA

Effective Hand Hygiene Saves Lives University of Geneva Hospital – 40% HAI reduction Presbyterian Healthcare Services – 51% MRSA reduction; savings = $276,500

Effective Hand Hygiene Saves Lives Despite such a simple step (implementation of a hand hygiene initiative), the compliance rate in the U.S. is only 50%

Create a Hand Hygiene Compliant Culture Develop interpersonal infrastructures for peer enforcement and practice Evaluate and improve the reliability of hand hygiene on a continuing basis Empower patients to be their own healthcare advocates – It’s OK to ask if they “washed” their hands

Assessment Tools To evaluate results of hand hygiene efforts, compare: Baseline hand hygiene compliance rates and perceptions among healthcare workers, with Baseline incidence/transmission MRSA rates for the Qsource project unit Consider distribution of a questionnaire for baseline culture and knowledge assessment

Training/Education Onsite training based on the “My 5 Moments for Hand Hygiene” approach, using situational skills and expertise coaching (Train-the-Trainer) Training for observers using a “bundle” approach with competency checkoffs in the unit Indications and procedures using teamwork and transparency

Training/Education Protocols for hand rubbing and hand washing Assessment of the availability of an alcohol-based hand rub at the point of patient care “Reminders” for healthcare workers regarding hand hygiene – Key tools to prompt healthcare workers – Informing patients and visitors of the standard of care

Training/Education – “Come clean” reminder cards summarizing when to perform hand hygiene – Reminder signs using staff and physician champions

“Come Clean” reminder cards “Champion” Posters

Observation Form Document collection of hand hygiene data through observation during routine care Regularly monitor for sustained improvement and to identify areas of opportunity requiring further interventions

Promote a Climate of Safety Active participation at both institutional and individual levels Awareness of individual and institutional capacity to change and improve hand hygiene culture Partnership with patients

Be Creative

Step Out of the Box

Provide Positive Reinforcement

… or a simple Thank You

Hand Hygiene Coordinator Profile Professional Understanding of hand hygiene and infection control issues Quality- and safety-oriented Well respected Accessible to frontline staff “Having the ear of” management staff

Hand Hygiene Coordinator Tasks Propose an Action Plan incorporating: – WHO guidelines – CDC guidelines – Current facility-level guidelines Discuss with senior-level managers Coordinate implementation at all stages Lead the training of trainers and observers

How Qsource Will Help Provide toolkit and training for the trainers and observers in the project unit Prepare baseline evaluation data Disseminate results among key initiative players Evaluate MRSA/hand hygiene rates in the project unit Determine how to present data and use the results to further the project goals

Your Specific Actions Provide link for Qsource culture/knowledge assessment Distribute assessment materials and baseline data and provide practical training at educational sessions Provide strategic support for performing hand hygiene and lead by example Report hand hygiene observations and results monthly Conduct regular meetings of the team/committee to monitor progress, overcome potential obstacles, and adjust plans, if necessary Ensure regular, critical data feedback to frontline and executive staff Enter MRSA LabID/infection surveillance events in NHSN with conferred rights to Qsource

Questions?

This material was prepared by Qsource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. QSource-TN-PS Thank You! Deborah Scott, RN Quality Improvement/Infection Prevention Specialist Phone: ext