Healthcare-associated infections can prolong hospital stays, induce long-term disabilities, raise costs for patients and even result in loss of life. Luckily, the simple act of handwashing is the primary measure to reduce infections.
But it's not that simple.
Most people know when to perform hand hygiene at home and in the community, but a healthcare worker may need to perform hand hygiene several times throughout an encounter with a patient or a patient's environment. The CDC and the World Health Organization consider inadequate hand hygiene to be one of the most important contributors to infections.1,2
Through data collected by teams such as Hand Hygiene Patrol Champions at the University of Maryland Medical Center in Baltimore, we know healthcare employee compliance rates are on the rise due to proper education, accessible soap and water or hand sanitizer, and reinforced messages among ancillary staff members and patients and their families.
Victoria Phelps, BSN, RN-BC, led a program with the motto of "All Hands to the Pump" on the vascular surgery unit at University of Maryland Medical Center.
"We set out to improve our hand hygiene rates and get them as high as possible," shared Phelps. As a result of the initiative, handwashing compliance reached 100% on her unit at one point.
All Hands on Deck
Studies show continuing education is needed to inform and remind healthcare workers of the indications for hand hygiene.
"We discovered that across the board, proper hand hygiene decreased infections in the hospital, reduced the length of hospital stays and decreased costs for patients and the hospital. Most importantly, the practice decreased morbidity rates," stated LaTonya Macklin, RN, BSN, OCN, physician resource nurse, University of Chicago Medical Center.
As co-chair of the Quality Resource Nurse program, Macklin was involved in planning and implementing the hand hygiene initiative while she worked on the hematology/oncology unit. University of Chicago Medical Center appoints a staff nurse as the point person for quality improvement programs. The nurse's role is to disseminate information to the corresponding department and ensure the staff is educated and carrying out the initiative.
Macklin raised awareness on her unit about organisms that remain on inanimate objects and potentially infect a patient. A common scenario, she explained, is a healthcare worker may have organisms on her hands from touching something and not following proper hand hygiene. Then she picks up a pen, transfers the organisms to the surface of the pen and then carries the pen to another individual.
Education is the best defense, according to Macklin. She created packets to teach the staff what organisms are, how long they stay on an object and the best way to get rid of them.
If soap and water are not available, hand hygiene experts recommend using an alcohol-based hand sanitizer that contains at least 60% alcohol. Hand sanitizer dispensers are increasingly found in hospital hallways, patient rooms and waiting areas.
"On our unit, we have bottles of hand sanitizer posted on the wall in front of each patient's room and at the nurse's station," Phelps explained. "Everyone who walks through the door is educated about using the dispensers whether you are a patient, physician, visitor or family member."
In addition to educating people verbally and by example, the vascular surgery unit's admission packet at University of Maryland Medical Center includes a flyer about the benefits of hand hygiene.
"The secretaries are often the first people you encounter in a healthcare setting, so it's imperative that they are on board with the program," Phelps said. "Before a patient even gets to his room or meets his physician, the secretary has already begun the hand hygiene education."
Phelps insisted that, although she was the chairperson, the initiative was a collaborative effort that involved everyone from physicians to secretaries. "The investment of all staff members is what made it successful," she added.
Collecting Data & Decreasing Infections
Other factors that may influence whether a patient becomes infected include equipment and environmental sanitation practices, and adherence to recommended practices such as using maximal barrier precautions during central line insertions.
The program at University of Chicago Medical Center began two years ago with a more global approach. Statistics were gathered and then shared throughout the hospital.
But then the focus shifted to more specific indicators on the nurse unit, Macklin explained. On the hematology/oncology unit where she was working at the time, Macklin observed there was very little immunity because most patients were getting bone marrow transplants. As a result, the patients were commonly getting central line blood infections. "We wanted to stop the incidences of infection," she said.
"We began the one-year program in January 2012 to reduce central line blood infections by handwashing and using hand sanitizer," Macklin said.
The initiative was more controlled than the hospital's global program because it occurred only on one unit. "We started with education and then made sure that hand sanitizer was available everywhere," Macklin explained. "We educated the staff and patients and families on the hand hygiene initiative and asked for their help."
Patients were given their own bottle of hand sanitizer to use if they were bed bound or following a trip to the commode. The hospital uses sanitizing wipes to clean inanimate objects such as dialysis machines and patient food trays.
"We instruct people to use gloves with the sanitizing wipes in an effort to reduce the organisms from transferring to another surface," Macklin said. Further, she stressed the need to change gloves after an encounter.
Raising the Compliancy Rates
The University of Maryland Medical Center's initiative on the vascular surgery unit used "Secret Shoppers" to monitor and report compliancy. "Repeat offenders are reported to the employee's supervisor and we have authority and support of our manager to do that," Phelps shared. "These individuals are held accountable."
Phelps discovered that some people may need to be constantly reminded but, for the most part, many are compliant with the program because they understand the implications if they do not participate.
Communication is the biggest part of education, according to Phelps. "We focus on making people aware with constant reminders of how important it is," she said. "We have huddles during day and night shifts to discuss the hand hygiene score each month."
The University of Maryland Medical Center's program selected employees or "Champions" from all disciplines to join the initiative. The Champions were asked to sign a letter stating their comfort in addressing all individuals in the department about their participation in the program.
The goal was to make the hand hygiene rates more transparent. Each unit posted a large board that breaks down compliancy rates by department. The data on the boards are collected by members of a hospitalwide infection control group who conduct their own audits.
Macklin initially functioned as a secret shopper, a role that required her to monitor everyone on her unit entering and leaving a patient's room. The unit conducted audits weekly to determine if patients were aware of what hand hygiene is and to monitor if they had what they needed. "Then we would quiz patients about how to protect themselves and would ask if a staff member had discussed the issues with them," Macklin said.
Patients and family members were held accountable for their follow through with the program and the staff was held accountable for verbalizing the various ways to practice hand hygiene, Macklin explained. "Patient awareness improved quarterly," she said.
The unit witnessed a decrease in central line blood infections but, because of other hygiene initiatives going on in the hospital at the same time, they are unable to determine how much was due to this initiative specifically.
Regardless, staff became more aware of the importance of practicing hand hygiene and making sure patients were comfortable with and aware of the hand hygiene initiative.
On the Horizon
"One of my goals is to be a part of the initiative in the whole medical center," Phelps shared.
In the short term, she is in the process of producing a hand hygiene music video. It's a spoof of a popular song with the intention of educating people.
"The song has been recorded and we start filming next month," she explained. "It's a fun and creative way to share the importance of hand hygiene."
"Seeing all of the success that we've achieved has been enjoyable for me," Phelps stated. "As evidenced by our concrete data, we are doing very well."
Macklin's ultimate goal is to implement the hand hygiene initiative in the network's outpatient setting, where she recently began working.
"I'm trying to create the quality resource nurse role for outpatient that is modeled after the inpatient side," she shared. "I am hoping this will help with the implementation of many initiatives, but in the short term, monitoring hand hygiene."
References for this article can be accessed here.
Rebecca Mayer Knutsen is on staff at ADVANCE. Contact: firstname.lastname@example.org.