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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Page 40 of 44

40 ICT September 2018 As we have seen, the Joint Commission requires healthcare organizations to have a hand hygiene program and to show steady improvement in compliance with the guidelines. A healthcare organization can implement hand hygiene guidelines established by either the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO). In 2016, Jacqui Reilly, PhD, professor of infection prevention and control at Glasgow Caledonian University in Scotland, published research indicating that the WHO's six-step hand hygiene technique is superior to a three-step method suggested by the CDC in reducing bacteria on healthcare workers' hands. During the randomized controlled trial in an urban, acute-care teaching hospital, Reilly and colleagues observed 42 physicians and 78 nurses completing handwashing using an alcohol-based handrub after delivering patient care. The six-step technique was determined to be microbiologically more effective for reducing the median bacterial count (3.28 to 2.58) compared to the three-step method (3.08 to 2.88). However, using the six-step method required 25 percent more time to complete (42.50 seconds vs. 35 seconds). "One of the interesting incidental fndings was that compliance with the six-step technique was lacking," Reilly says. "Only 65 percent of providers completed the entire hand hygiene process despite participants having instructions on the technique in front of them and having their technique observed. This warrants further investigation for this particular technique and how compliance rates can be improved." S o m e t i m e s , s ce n a r i o s a r e n o t a s cut-and-dried, and so Garcia-Houchins says that surveyors will ask about the facility's official hand hygiene policy and what they have adopted as the evidence-based guideline that dictates practice. "Facilities have the option of adopting the CDC guideline or they can adopt the WHO guideline," she confrms. "More and more facilities adopt a policy that requires staff perform hand hygiene when entering a patient's room and when exiting a patient's room. For example, if a nonpatient-care worker such as an environmental services worker walks into a patient room, he/she should have performed hand hygiene prior. If the patient says to that individual, 'Do you mind handing me that water pitcher,' his/her hands would already be clean because he/ she just walked in and would have previously performed hand hygiene, so organisms don't move from room to room." When it comes to elec tronic hand hygiene compliance monitoring, Garcia- Houchins says surveyors are witnessing an increase in the number of institutions that use automated systems. "Many facilities that use electronic monitoring have staff that can't wait to tell the surveyor about it, as they are very proud. The staff often boast about the automated system. For example, upon entering a nursing unit, a facility representative may say, 'We are doing such-and-such for hand hygiene and this is the kind of system we have chosen, this is how it works, and this is the feedback we have provided to staff. Clinicians are incredibly creative and in many facilities, surveyors don't have to ask about what is being done to inform hand hygiene; while looking around the facility, it is often very evident that the institution is committed to hand hygiene. The Joint Commission's surveyors are very savvy when it comes to noticing the favor of the hand hygiene efforts. From the moment they enter the healthcare facility, the surveyors are looking at what types of media are being used. Nowadays, when we walk into a facility, often at the door there's a poster that says, 'Cover your cough and wash your hands.' These signs provide the surveyor with a feel for the facility's approach to hand hygiene. Many facilities implement a hand hygiene campaign such as "Pump in, pump out.' I visited one facility that featured beautiful posters on their elevator doors that illustrated the hospital's commitment to hand hygiene. The message was emphasized every time staff interacted with patients." The movement around fnding creative ways to boost hand hygiene compliance is gaining momentum in many facilities. Garcia- Houchins points to a recent anecdote: "A presenter at the hand hygiene symposium at APIC discussed the importance of staff taking ownership of hand hygiene. Staff need to 'own' their unit, and when there is a visitor they remind them that 'you are visiting my home so you need to wash your hands.' It is similar to the custom of removing their shoes at the door at home — that is their policy and they are holding people accountable to follow it. Those types of units are ultimately successful. I know the presenter, and what she didn't tell the audience was that her own unit is extremely committed to improving hand hygiene and enthusiastically follow her lead. This manager had her phone set up so that the electronic hand hygiene monitoring system alerted her phone if compliance fell below 60 percent. So, she would get notifed in the middle of the night by her phone and would subsequently call her unit each time. When the unit manager was away, her secretary stepped in and sent out a text message to staff alerting them, 'Hey guys, our hand hygiene compliance is dropping.' That unit has been extremely successful because washing their hands has become an accepted way of practice on their unit." If a healthcare facility receives an RFI, it must state in its plan of corrections how it will address and correct its shortfall in hand hygiene practice. "Facilities that receive an RFI in hand hygiene usually seek clarifcation of how to better understand the problem and how to improve," says Garcia-Houchins. "It may be that the organization recognizes the need to step up hand hygiene efforts on a particular unit and will devote additional resources to achieving that. There is a whole spectrum of responses to RFIs being seen currently, and every facility gets to make its own decisions about how it can best monitor and improve practices. I always remind people that 'perfect is the enemy of good,' meaning the frst step to successful hand hygiene is getting staff to wash their hands consistently. Once they consistently commit to hand hygiene, then they can work on their technique. A healthcare organization cannot go from bad to perfect; it must get to good frst."

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