This is a quick followup to the captioned post, (part 1). Commenters highlighted the Joint Commission 2010 report “Hand Hygiene: Best Practices from Hospitals” [PDF]. That’s an excellent resource. See also the Joint Commission Newsroom on the hand-hygiene topic. From these resources, here’s a few excerpts illustrating the complexity of this challenge. It’s good to see the hospitals adopting process engineering methods.
From the NY Times “A Hospital Hand-Washing Project to Save Lives and Money”:
(…) The disease control agency estimates there are 1.7 million infection cases a year in hospitals and that 99,000 patients die after contracting them (although infection may not be the sole cause). It projects the cost of treating those patients at $20 billion a year.
Despite the daunting statistics, and what would seem to be the ease of saving thousands of lives, old habits have proven stubbornly resistant to cultural change. Research has found that constant vigilance, individualized solutions and an upending of hospital hierarchy are all required.
“It seems really simple, but even this one turns out to be complicated,” Dr. Chassin said in an interview.
Some excerpts of good/bad news from the study report:
(…) Another surprising example was at Cedars‐Sinai Medical Center. The surveillance team cultured everything in the patient environment and discovered that privacy curtains—required around all patient beds in California—were colonized with multi‐drug resistant organisms in some rooms. According to chief medical officer Michael Langberg, MD, the information “stunned” them. “Patients in the room did not have infections, but the organisms were sitting on the privacy curtains,” he said. Even if health care personnel were doing effective hand hygiene before walking in the room, they might touch the curtains without realizing it. The hospital swapped out every curtain and changed how and when they cleaned them. Subsequently, zero such organisms have grown on the curtains, said Langberg. This hospital also addressed the potential spread of germs on lab coats by adding hooks outside patient rooms, which allows health care personnel to easily remove their coats before entering a room.
(…) By bundling supplies and tasks, health care personnel have fewer opportunities to be in patient rooms and fewer opportunities when they need to wash their hands, likely increasing compliance. “We looked at workflow and how to standardize it, so we decreased ins and outs of patient rooms,” said Miller. Changing the location of dispensers to fit in people’s workflow also increased compliance.
(…) Since June 2010, Virtua has been piloting technology and sensors worn by all health care providers. “Technology is making us look at our process,” said Kate Gillespie, RN, Six Sigma black belt. Though the hospital is still fine‐tuning that technology, Gillespie believes that in the long term, using technology will be helpful. “We cannot sustain secret observers,” she said. But having the technology has shown them their observations were “not that far off.” “We can see a correlation,” she added.
WFUBMC also focused on using an electronic method to monitor and increase compliance for hand hygiene. Health care personnel wear a real time location system tag equipped with infrared recognition that is activated when entering a patient care area. The tracker on the hand sanitizers, sinks, or pumps reads the tag and reports the activation. Tony Oliphant, RN, nurse manager, emphasized that the goal for the technology is that it does not interfere with the workflow. The badges are being modified so as not to hinder work. “We didn’t want to change the way people enter and exit rooms,” Oliphant said.
The new technology and its possibilities are “monumental in nature,” said Shayn Martin, MD, WFUBMC. “We are creating a system to track providers to perform hand hygiene on a scale that is substantially greater than our existing systems. It is continuous. It allows us to build reports for individual compliance.” He added, “We should be 100 percent compliant with hand hygiene. We want to be sure the system is highly accurate, does not give false data and does not impose on workflow.” Though using this technology “sounds big brother‐like,” Martin acknowledged, “the last thing we want is to create an environment that makes people nervous and makes it harder to do their job….[The technology] is a way to approach 100 percent [compliance].”
(…) Johns Hopkins Hospital also used red lines at the thresholds to all patient rooms to serve as a reminder to “wash or don’t cross,” said Kulik. At Memorial Hermann The Woodlands, the door thresholds in the ICUs have red tape that goes up the side of the door with an arrow pointing to where the hand sanitizer is located. That area is marked “patient zone” to remind health care personnel and all visitors that they are crossing this threshold and should clean their hands. “We know hand hygiene has become a habit when a serious situation develops in the ICU and we see health care providers pause in the doorway to get hand sanitizer,” said Parks. “It is the last point at which a health care worker can get it right and prevent infection,” observed Rob Morehead, RN, infection control practitioner. “If we wash hands, we can still get it right,” he added.