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Clean Slate

Hospitals are reducing infection rates with successful initiatives like hand washing, communication and culture change

Vol. 10 • Issue 2 • Page 8

Eileen Finerty, MS, FNP, RN, CIC, nursing director for infection control and occupational health services at the Hospital for Special Surgery, New York, NY, is proud her facility has one of the lowest infection rates of any hospital in the U.S.

The hospital recently earned a commendation from the New York State Department of Health for its low infection rate in patients who come in for total hip replacements.

"Infection prevention is not an easy process; rather, it's a continuous one for us," she explained. "I came here 10 years ago and have been building the program ever since, but the foundation was well-established when I got here."

Culture of Prevention

Finerty said she appreciates the support she receives from top management.

"Infection prevention is a priority," she noted. "Physicians are the big drivers for infection prevention in the OR and after surgical procedures, but it's the nurses who pull it all together.

"Infection prevention isn't just an annual in-service - it's part of our culture. I provide nurses with ongoing feedback in the form of data and case studies so they have a bird's eye view of what happens when a patient does get an infection."

Acknowledging infection prevention is a hot topic in healthcare today, Finerty noted eight of the initiatives on her hospital's quality dashboard represent infection-related topics.

"Infection prevention has to be part of how we care for our patients every single day, not just a bundle or program we implement and then abandon," she emphasized. "There are a lot of opportunities for nurses at the bedside to explain issues to patients, look at what's happening following a surgical procedure, and work with infection preventionists on their unit."

From OR to Med/Surg

As a top-ranked hospital for orthopedics and rheumatology, the Hospital for Special Surgery has an active operating room with a plethora of surgical procedures going on at any given time.

"We've dedicated a full-time position to an experienced perioperative nurse who works in the OR, and her expertise lets us know exactly how perioperative practice works," Finerty said. "She understands quality standards and can identify any issues we need to address.

"That position allows us to continue strengthening our infection prevention program in the OR."

Finerty and her colleagues also support standard infection-prevention measures such as hand hygiene, good ventilation in the OR, and cleaning and disinfection of equipment.

Patients who do develop a contagious infection are placed in a private room as an added precaution.

Systemwide Approach

Susan Ventura, MSN, RN, director of surgical services for Southcoast Hospitals Group, Fall River, MA, described the importance of a systemwide approach.

"It's important to keep the awareness about proper hand hygiene high for all healthcare workers," she said. "One of our initiatives within our three-hospital system is an interdisciplinary, systemwide hand-hygiene team that develops effective strategies for infection prevention."

Representatives from nursing, environmental services, infection prevention, professional development, laboratory services and the medical staff participate at Charlton Memorial Hospital, Fall River; St. Luke's Hospital, New Bedford; and Tobey Hospital, Wareham.

Southcoast's interdisciplinary team instituted a process to quickly implement and test improvements in clinical practice.

"For example, we've identified trial units, one within each hospital, to implement changes and we invited a representative from each of those units to join our team," Ventura said. "If a particular change doesn't improve compliance with hand hygiene, we can discontinue it. If it does work, we can spread it to other units within each hospital."

The hand-hygiene team came up with the idea of creating posters to display data about hand hygiene compliance.

"It's a simple, visual display with a line graph that quickly shows busy clinicians whether the trend is going up or down," Ventura said. "We incorporated some colorful information from the CDC's Clean Hands Save Lives campaign, and shared data to increase awareness and create a bit of competitive spirit between units. Our preliminary review of the trial data shows an increase in compliance with hand-hygiene measures, and we'll continue to monitor that trend."

Spreading the Word

The team also completed functional assessments of the environment within each hospital, looking at the distribution of dispensers for alcohol-based hand sanitizers.

"Are they available? Are there enough of them? Are they located at the points that facilitate staff using them?" Ventura asked. "Those assessments identified opportunities to place more of them at locations where staff needs them, including more in patient rooms."

Ventura and her colleagues are committed to transparent communication about infection prevention practices.

"Hand hygiene monitoring data is compiled monthly in two ways - by department and by discipline," she explained. "It's then available on our hospital intranet for leaders in any department to access.

"So a nurse manager can see what the compliance is like for her unit as a whole, and also look closely at compliance for employees such as nurses, dietitians and physicians who care for patients on that unit," Ventura added. "This allows the manager to identify who needs more education and follow-up."

Grassroots Efforts

Mary Beth Farley, BS, RN, manager of infection prevention and associate health at Seton Health, Troy, NY, described the importance of developing grassroots champions.

"Our nursing managers have been supportive of our efforts around infection prevention," she said. "We have one nursing unit involved in the MRSA Reduction Project, and the patient care aides from that unit are conducting hand-hygiene monitoring. They're great champions among the nursing staff.

"I also submit data to our clinical excellence committee so everyone knows where we stand."

Hand hygiene is routinely incorporated into every infection-prevention promotion.

"The publicity around H1N1 really boosted compliance with hand hygiene among hospital staff, physicians and visitors," Farley noted.

Public Awareness

Eileen Paus, MS, RN, infection preventionist at Copley Hospital, Morrisville, VT, also credited the media hype around H1N1 with raising awareness of the importance of infection prevention.

"We were able to accomplish things quickly within our health system," she said. "For example, using the CDC recommendations for improving compliance with hand hygiene, we added alcohol-based hand cleanser dispensers in addition to the ones we currently have on walls outside of patient rooms.

"The new dispensers are hung on the wall opposite the foot of the patient's bed," Paus said. "We then instructed staff to use the dispenser in the patient's room where patients can observe hand hygiene being performed."

In addition to leading Lunch and Learn sessions for hospital staff, Paus brought in an outside expert to emphasize the importance of hand hygiene.

"[I've] put up some different posters to remind staff, as well," she said. "For example, the one in the cafeteria has a picture of an animal and says, 'Go wash your paws.' That gets people's attention in a fun way. I've also distributed a lot of individual hand sanitizers that staff can wear on their belts or carry in their pockets."

The before-and-after data from Copley's Press Ganey surveys have been encouraging.

"We're a 25-bed critical access hospital and all know one another, so I can't really observe nurses and physicians anonymously," Paus said. "But our Press Ganey scores tell us patients have noticed an increase in hand hygiene since we installed the units in patient rooms, and they like what they see."

Sandy Keefe is a frequent contributor to ADVANCE.


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