1. Avondale Community Hand Hygiene Team
Eric Robinette
Anita Brentley
Teresa Worthen
Andy Beck

2. Background
Infections are a major cause of hospital days for kids from Hamilton County and even more so for kids from Avondale
Respiratory Infections (e.g. bronchiolitis) – 13 days per 1000 children per year in Avondale (4x County)
Asthma Exacerbations triggered by respiratory viral infections – 20 days per 1000 in Avondale (2x County)
Gastrointestinal Infections – 2 days per 1000 in Avondale (2x County)
Infants and toddlers are at a greatest risk of hospitalization from communicable infections
Children in daycare at increased risk of communicable infections
Reliable and effective hand hygiene is the most effective and proven intervention to decrease infections in group settings such as daycares
Total Disparity: 20 hospital days per 1000 children per year would be prevented if the IPBDs for asthma, respiratory infections, and gastroenteritis in Avondale were the same as the Hamilton County Average

3. Aims and Measurement
Global Aim: Keep the children attending the CWFF Child Development Center in Avondale healthy and in school with their friends.
Specific Aim: Decrease the amount of missed school days for illness from X to Y by December 2018 (numbers to be determined).
Change Idea: Develop and implement highly reliable processes for effective hand hygiene at key moments while simultaneously building capacity within the daycare setting.
Conceptual Definition: The amount of missed child-days of school for children in the pre-school classroom.
Operational Definition: The count of missed child-days of school per week for children in the pre-school classroom as documented in the call-log.
Process Measures: TBD

4. Preliminary Observations
ODJFS Daycare Regulations identify hand hygiene “moments” (examples, not exhaustive):
* Upon arrival
* After toileting
* Prior to eating
* After contact with bodily fluids
* When visibly soiled
ODJFS Daycare Regulations give no guidance about reliability or effectiveness
All moments are observed at the daycare
There are challenges around reliability such as:
* Technique
* Recontamination (i.e., after handwashing but before eating)
* Reliability (i.e., children evading handwashing)

5. Next Steps Testing: Education on reliability science and methods
Process mapping
Conduct simplified failure modes effects analysis
Plan PDSA’s/Tests of Change
Develop process measures for individual PDSAs
Begin PDSA testing
Measurement:
Complete baseline data collection and finalize operational definition and AIMs
Add process measures as above
Considering measuring engagement/activation as well

6. CONTACT US Eric Robinette – Eric.Robinette@cchmc.org
Anita Brentley –
Teresa Worthen – CWFF Child Development Center
Andy Beck –