Infection Control Today

SEP 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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38 ICT September 2018 www.infectioncontroltoday.com Sylvia Garcia-Houchins, MBA, RN, CIC, director of infection prevention and control in the Division of Healthcare Improvement at the Joint Commission, emphasizes that hand hygiene compliance "should have been on the radar for many, many years." Garcia- Houchins, a former infection preventionist with more than 30 years of experience in infection prevention and control in both hospital and long-term care settings, adds that it has always been expected that hospitals have a goal to improve hand hygiene. "Many healthcare personnel and facilities have taken that standard to heart, have actionable goals, and have improved over time, while others have stagnated," she says. "During the survey process you may hear that a facility's hand hygiene compliance rate is 99 percent, but still see personnel not washing their hands and there is evidence of the transmission of organisms that are transmitted by contact, we are thinking that there is a disconnect somewhere — at an apparent 99 percent compliance rate, maybe you should start looking at it more closely." Garcia-Houchins continues, "There are many more studies coming to the forefront about the importance of hand hygiene and how to protect patients. We know it is the No. 1 way not just to protect our patients, but to protect our staff, visitors and everyone else who walks through the door. A lot of facilities say they are conducting hand hygiene observation and that they are at 99 percent compliance, but when you run a secret-shopper program, your organization's actual rate may be about one-third of what you are observing. I advise facilities to do a reality check to see if your organization is actually performing well or not." As a statement from the Joint Commission points out, "Because organizations have had since 2004 to implement successful hand hygiene programs, The Joint Commission has determined that there has been suffcient time for all organizations to train personnel who engage in direct patient care. While there are various causes for HAI, the Joint Commission has determined that failure to perform hand hygiene associated with direct care of patients should no longer be one of them." Garcia-Houchins says that the Joint Commission is not on a mission to destroy staff and facility morale by issuing RFIs during surveys, but rather seeks to help institutions' patient safety goals. "I attended a hand hygiene symposium at this year's APIC annual meeting where the ballroom was full by 6 a.m.," she recalls. "A ballroom full of people who would think enough about hand hygiene to get up at 5 or 5:30 in the morning and attend a symposium on how to improve hand hygiene indicates that people are focused on this issue. I heard a lot of concern on the part of infection preventionists; someone got up and said, 'If you have one instance of not washing your hands, you are going to be found out of conditions for participation. The Joint Commission takes it seriously, and you can't do electronic HH monitoring because it's going to show that your hand hygiene rate isn't as good as your observation rate.' The participant who commented started a conversation about the Five Moments and the challenge that electronic systems cannot monitor the Five Moments, and actually, no one presently known can monitor the Five Moments correctly. I had to get up and I said, 'I have been in this line of work for 35 years and the Joint Commission is not out to get anybody, we are doing this to improve the safety of patients, staff and visitors, and part of the survey process is to look at best practices — and hand hygiene is defnitely a best practice — and that the Joint Commission is working to ensure that people are moving toward that ultimate goal of 100 percent." Garcia-Houchins continues, "Now, if you are at 25 percent, and the surveyor walks around and sees that no one is washing their hands, there's going to be a real problem — that could be a condition-level fnding. But if the surveyor is walking around and people are washing their hands and the data shows that the healthcare organization was at 50 percent and now it is at 60 percent, you are making progress. Surveyors are going to look at it from a what-are-they-seeing, what-is-the-data-showing perspective, looking at the infection risk. For example, if someone is doing something invasive, such as putting in a central line, and the surveyor is watching that procedure and he/she says, 'Gee, no one washed his/her hands before they put on their gloves,' then for sure, it is going to be a much more serious situation than if the healthcare worker walked out of the room and forgot to wash his/her hands — until hopefully someone stopped him/her and said, 'Hey, you forgot to wash your hands.' Surveyors are looking for that cultural part of hand hygiene. They observe if one clinician advised, 'Excuse me, you forgot to wash your hands' and the other clinician says, 'Oh thanks, I forgot,' or 'I was thinking about something else.' Those are the kinds of situations that the Joint Commission is investigating; surveyors are looking not just for whether staff wash their hands, but are they monitoring it, are they trying to improve their hand hygiene rate, are they culturally aware and reminding each other?" In general, surveyors issue an RFI to organizations for failure to implement and make progress in their hand hygiene improvement programs, according to NPSG.07.01.01. With the exception of the Home Care and Ambulator y Care Accreditation programs, observations of individual failure to perform hand hygiene were not cited as deficiencies if there was otherwise a progressive program of increased compliance. A surveyor has the latitude to determine how best to handle an observed breach of hand hygiene, Garcia-Houchins explains, noting that the process has evolved over the years to give sur veyors flexibilit y. "Even if the sur veyor is mid-sentence when addressing another issue, he or she still may be observing a healthcare worker walking in or out of a room without washing their hands," she says. "The surveyor may be looking around to see if anyone else noticed and stopped the healthcare worker to remind him/her to wash his/her hands. If appropriate, the surveyor may also say to a staff member, 'Hey, I just observed that person come out of the room and not wash his/her hands, can you go follow up with him/her? If the surveyor is in a critical location of the healthcare organization, for example, observing in the operating room, he/she might lean over to the accompanying staff member and say something quietly so he or she does not alarm anyone, but the surveyor also wants to make sure the correct procedure is performed for the patient." Ò Tere are many more studies coming to the forefront about the importance of hand hygiene and how to protect patients. We know it is the No. 1 way not just to protect our patients, but to protect our staf, visitors and everyone else who walks through the door. — Sylvia Garcia-Houchins, MBA, RN, CIC

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