Complying with the new patient safety goal
Rising patient infection rates. Adverse patient outcomes. Increased risk to staff. If these aren’t compelling enough reasons to comply with recent hand hygiene guidelines from the Centers for Disease Control and Prevention (CDC), consider this: The only new 2004 National Patient Safety Goal from the Joint Commission on Accreditation of Healthcare Organizations addresses this area specifically.
In addition, the Joint Commission’s isn’t the only survey you have to worry about, says James Marx, RN, MS, CIC, a San Diego-based infection control and epidemiology consultant. "Both state and federal surveys in acute, long-term care, and other facilities are also focusing on hand hygiene," he stresses.
According to the CDC, 30,000 deaths occur each year as a direct result of improper hand hygiene.
The recently issued guidelines recommend the following performance indicators be used to measure improvements in hand hygiene adherence:
1. Periodically monitor and record adherence, by the number of hand hygiene episodes performed by personnel, and the number of hand hygiene opportunities, by unit or by service. Provide feedback to personnel regarding their performance.
2. Monitor the volume of alcohol-based rub or detergent used for hand washing or hand antisepsis used per 1,000 patients.
3. When outbreaks of infection occur, assess the adequacy of health care worker hand hygiene.
Here are some ways to improve hand hygiene compliance:
• Encourage peer review monitoring.
Health care workers are monitored by both supervisors and peers in the facility’s 28 operating rooms, says Christy Dempsey, BSN, CNOR, director of perioperative services at St. John’s Regional Health Center in Springfield, MO.
"The operating room is really a perfect place to monitor each other," she says. "The staff and surgeons often scrub at the sinks together and have an opportunity to observe each other’s techniques."
On occasion, a staff member may question a surgeon’s or other staff member’s hand hygiene techniques, says Dempsey. When this occurs, the concern is brought to the attention of the supervisor or OR manager, who then discusses the issue with the surgeon and, when warranted, involves the infection control department, she says.
• Address hand hygiene in performance reviews.
During annual performance reviews, feedback is provided about hand hygiene compliance, says Dempsey. The annual performance review is an opportunity to provide feedback in all aspects of the employee’s performance throughout the year, she notes.
"If a problem is identified in any area, including hand hygiene, which is critical in the surgical setting, this would be addressed in the review appropriately — depending upon the severity of the problem," she adds.
• Monitor volume of hand hygiene items.
Since the facility has its own distribution center, purchase orders for particular products can be monitored closely, Dempsey says.
"We are able to identify areas of underutilization of hand hygiene items by those purchase orders and trend this to the infection rates for those particular patient care areas," she says.
During monthly and quarterly infection control meetings, infection rates are discussed and each surgical site infection is reviewed in detail, says Dempsey.
The meetings are attended by representa-tives from all areas, including nursing, internal medicine, surgical specialties, and administration, she adds.
"We are very diligent in our hand washing, surgical scrubs, and surgical preps to insure a low infection rate," Dempsey adds. "Any issues with regard to surgical infections is researched in great detail. This may include step-by-step analysis of the surgical case, setup, procedure, preoperative, and postoperative care."
If there is a spike in infection rates, such as sternal wound infections, every process is closely reviewed, she says.
"We trend personnel in the room, and we have infection control representatives watch high-risk cases and closely monitor sterile technique," she continues.
As an integrated system, more information is obtained from physician officers since they are employed by the organization, notes Dempsey. "So, we are able to trend infections with that data that might not otherwise be reported."
• Give inservices on an ongoing basis.
It may be difficult to get staff to accept the new recommendation that alcohol hand sanitizers, not soap and water, are the new gold standard, Marx says. "This has been a struggle for health care professionals who have been told by infection control that alcohol was only an adjunct to soap and water hand washing."
When the facility switched to using a waterless surgical scrub, several inservices were given to staff, Dempsey explains. The vendor provided inservices on all shifts until every employee was educated on the proper use of the product, she adds.
"This is now repeated on an annual basis for all employees, so that competency is maintained," Dempsey says. "This ensures that the product is being used properly, so that the maximum benefit is provided for the patient."
• Ask staff for suggestions.
When the Joint Commission identified surgical site infections as a sentinel event, a task force for perioperative services was established, she reports.
"We brought staff together and explained what the Joint Commission was looking for. We asked them how we could improve, and they came up with some fabulous suggestions," Dempsey says.
The suggestions resulted in changes in setup and draping techniques, and making sure that equipment was not brought in and out of the room frequently, she adds.
"A lot of the solutions were no-brainer kinds of things; but to have the staff come up with it and see us implement it, made a big difference," Dempsey points out.
Here are two changes that were implemented as a result of staff suggestions:
— The number of students observing in the OR was reduced, with a maximum of two per room established.
"As a result of this suggestion, the management team focused on determining which students really needed to be in the OR, and finding a way to distribute the students so that traffic and personnel in the room was kept to a minimum," Dempsey says.
— Housekeeping personnel were added to areas of high patient turnover, to ensure that these areas were appropriately cleaned, even during peak patient census hours.
• Make it easy for staff to use hand hygiene items.
Alcohol gel was placed in the hallways prior to the CDC guidelines, says Dempsey. After the guidelines came out, foam was added to each patient room, located on the wall in plain sight, she says.
"You need to provide systems that are easily accessible and user-friendly, and conveniently located for health care workers to use," she adds.
However, you also should consider possible safety hazards when choosing locations of alcohol hand sanitizers, Marx says, pointing to a recent statement issued by the Washington, DC-based Association for Professionals in Infection Control and Epidemiology, which recommends that these products not be placed in exit corridors. (To access the document, go to www.apic.org and click on "Guidelines for Hand Hygiene in Health Care Settings.")
"There is a theoretical possibility that alcohol-based products could accelerate a fire in the hallway," he explains.
"However, local fire marshals have ruled differently, so the facility should check with the local fire department," Marx adds.
[For more information on the CDC hand hygiene guidelines, contact:
• Christy Dempsey, BSN, CNOR, Director of Perioperative Services, St. John’s Regional Health Center, 1235 E. Cherokee St., Springfield, MO 65804. Telephone: (417) 820-2302. Fax: (417) 888-7793. E-mail: [email protected].
• James Marx, RN, MS, CIC, Broad Street Solutions, Editor, P.O. Box 16557, San Diego, CA 92176. Telephone: (619) 656-7887. E-mail: [email protected].]
Rising patient infection rates. Adverse patient outcomes. Increased risk to staff. If these arent compelling enough reasons to comply with recent hand hygiene guidelines from the Centers for Disease Control and Prevention (CDC), consider this: The only new 2004 National Patient Safety Goal from the Joint Commission on Accreditation of Healthcare Organizations addresses this area specifically.
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