Transcript Hand Hygiene - IQIC for Congenital Heart Surgery

International Quality
Improvement Collaborative for
Congenital Heart Surgery
Vision
Facilitate a collaborative of healthcare
teams from around the world creating
a culture of patient safety & quality for
children receiving congenital heart
surgery in developing world countries
Mission
Our mission is to reduce
mortality and major
complications for children
undergoing congenital
heart surgery.
Data Entry Map
Ukraine
Poland
Belarus
China (Changchun)
Serbia
China (Shanghai)
Dominican Republic
Pakistan
India (Frontier)
Vietnam
Guatemala
India (Amrita)
India (Innova)
Columbia
Uganda
Brazil
India (Star)
Objective
• Create tailored QI strategies to reduce
mortality and major complications for
developing world programs.
•
Employ a telemedicine platform to
facilitate distance learning, dialogue,
disseminate knowledge & skills.
Drivers of Mortality
•
Team-based Practice through
Nurse Empowerment
•
Reduce Surgical Site Infections and
Bacterial Sepsis
•
Safe Operative Practices
Key Driver Diagram
Aim
Key Drivers
Safe Perioperative
Practice
Reduction
In 30 day mortality
associated with
congenital heart
surgery
Reduce Surgical Site
Infections &
Bacterial Sepsis
Team-based Practice
Change Strategies
Utilize a surgical safety checklist
to prompt and document
evidence-based process
measures (i.e. antibiotics given
within 60 minutes of surgical
incision)
Focus on hand hygiene for ALL
clinical personnel in contact
with patient care.
Empowering nurses
Evidence-based nursing practice
Scripting nurses in ward and ICU
on how to give reports
Accurate 24hr total patient intakes
and outputs
Accurate daily recording of patient
weight
Effective Communication-SBAR
Learning Modules
•
•
•
Contain QI strategies for each of the 3
drivers that impact mortality.
Each module contains a series of 3
educational sessions (one
session/webcast).
Sessions advance from beginning,
intermediate, and advance-level of
learning & acquisition of skills.
Learning Modules
• Learning Module I: Team-based Practice
and Nurse Empowerment
• Learning Module II: Reducing Surgical
Site Infection and Bacterial Sepsis
• Learning Module III: Safe Perioperative
Care
Timeline for Webcasts
2010 Timeline for Webcasts
Phase II
Level of Learning Modules
QI Strategies
Beginning Level
Learning Modules
Feb
Team-based Practice
2/17
Reducing Infections
Safe Surgical Practices
Mar
Apr
Intermediate Level
May
Jun
Jul
5/19
3/17
Aug
Sep
Oct
8/18
6/16
4/21
Advance Level
9/15
7/21
The color of each Learning Module corresponds to the date the
topic will be presented during that month’s webcast. For
example, Team-based practice will be the topic 2/17 and 5/19.
10/20
Preventing Health Care Associated
Infections:
Creating a Hand Hygiene Culture
Outline
• Define Health Care Associated Infection
• How Infections Occur
• Hand Hygiene
• Creating a Hand Hygiene Culture
What is a Health Care Associated
Infection ?
Definition
• A condition resulting from an adverse
reaction to an infectious agent, or to
toxins produced by the agent.
• An infection not present or incubating at
the time of admission
In Mexico
• Health care associated infections are
the third leading cause of death
• The cost of these infections equals 70%
of the entire budget of the Ministry of
Health
World Health Organization Global Patient Safety Challenge 2006
In Brazil and Indonesia
• More than half of neonatal patient
admissions get a health care associated
infection, with mortality rates between
12% to 52%
World Health Organization Global Patient Safety Challenge 2006
In the United States
• Health care associated sepsis and
pneumonia led to $8.1 billion in
increased health care costs in the years
1998 – 2006
•
Highest mortality rates were associated
with sepsis and pneumonia after
surgery
Eber et al. Archives of Internal Medicine 2010
Quality Improvement
• Programs that target:
 Education
 Hand hygiene
 Sterile device insertion
 Management of invasive devices
• Outcome of these efforts:
 Health care associated infection = Medical error
What is Needed for an Infection
to Occur?
3 elements:
• An infectious agent
• A susceptible person
• Mode of transmission
The Susceptible Patient
•
•
Host factors
Medical
interventions
 Central venous
lines
 Mechanical
ventilation
 Total parenteral
nutrition
Grohskopf et al: Journal of Pediatrics, 2002
Modes of Transmission
• Contact
• Droplet
• Airborne
• Common vehicle
• Vector
Modes of Transmission
Contact
•
Direct Contact:
 Person to person
Indirect Contact
 Hands of health
care workers
 Hospital equipment
 Hospital
environment
Modes of Transmission
X represents VRE culture positive sites
Modes of Transmission
Droplet
Respiratory droplets
carrying infectious
agents are
propelled short
distances by
 Coughing


Sneezing
Endotracheal
suctioning
Modes of Transmission
Airborne
Particles containing
infectious agents
that are small
enough to be
carried on air
currents or dust
particles
Modes of Transmission
Common vehicle:
• Food
• Water
• Medications
Vector:
• Disease is carried
by an animal or an
insect
Preventing Transmission of
Infection
The #1
intervention is
careful hand
hygiene by health
care workers
#1 Intervention:
Hand Hygiene
80% of transmission of infectious agents in
hospitals is by the hands of health care
workers.
#1 Intervention:
Hand Hygiene
Multiple studies
have demonstrated
hand hygiene
compliance of health
care workers to be
between 36 – 48%
World Health Organization Global Patient Safety Challenge 2006
#1 Intervention:
Hand Hygiene
Barriers to hand hygiene compliance
•
•
•
•
•
•
Guidelines for hand hygiene are not clear
Limited knowledge about infection
prevention
Products not available or near patient
Products cause skin irritation/allergic
reactions
Too busy
Forget
#1 Intervention:
Hand Hygiene
Hand hygiene
means:
Clean Your Hands
using antiseptic soap
and clean water
or
alcohol based hand
sanitizer
#1 Intervention:
Hand Hygiene
► Use alcohol hand sanitizer for
fast, efficient hand cleansing
► Use soap and water when:

Hands are visibly soiled

Patient has Clostridium difficile or
other infection caused by a spore
forming bacteria (anthrax)

Before eating

After using the toilet
• Hand hygiene video
•
•
#1 Intervention:
Hand Hygiene
When moving from a contaminated body
site to a clean body site during patient care
Before and after:
 Diaper changes
 Dressing changes
 Ostomy care
 Endotracheal tube suctioning
•
 Oral hygiene
When moving back to the patient after
touching equipment in the patient’s room
#1 Intervention:
Hand Hygiene
Other aspects of hand hygiene:
•
•
•
•
•
Dry hands before patient contact
Use hospital hand lotions
Avoid multiple use products: bar soap, cloth
hand towels
Keep nails short: less than 0.5 cm long
No artificial nails
#1 Intervention:
Hand Hygiene
Use of gloves:
•
•
•
•
Does not replace need for hand hygiene
Change gloves between patients
Wear gloves for contact with blood, other
body fluids, mucous membranes, non intact
skin, and wound dressings
Do not reuse gloves
Creating a Hand Hygiene Culture:
Stage 1
Form a hand hygiene team and include:
1. Doctors and nurses
2. Infection control experts
3. Hospital leadership
4. Other hospital staff
5. Parents and patients
Creating a Hand Hygiene Culture
Stage 1
• Name the hand
hygiene program
• Involve hospital
staff
• Identify role
models
Creating a Hand Hygiene Culture:
Stage 1
•
•
Evaluate barriers to hand hygiene compliance
Address areas to be improved:
 Supply of hand hygiene products
 Hand hygiene products available at “point of care”
•
•
 Preference of products
Educate hand hygiene teachers
Educate staff to observe hand hygiene
practice
Creating a Hand Hygiene Culture
Stage 2
Education
•
•
•
•
Educate staff on why hand hygiene is
important and when it is necessary
Provide training for new staff and annual
education review for all staff
Educate patients and their families
Educate staff to speak up when hand
hygiene is not performed
Video
Creating a Hand Hygiene Culture:
Stage 2
Observe practice and share results
• Collect baseline data
• Monitor hand hygiene practice
• Post practice results in visible areas
• Post reminders throughout the hospital
Hand Hygiene Observation Tool
Hand Hygiene (HH)
Physician
Opportunity
HH
Performed
Nurse
Opportunity
HH
Performed
Prior to initial
patient
contact
After removing
gloves or when
leaving the bedside
after contact
Before inserting or
manipulating an
invasive device
Hand Hygiene
Fun Fact
Singing Happy Birthday or your ABC’s while
washing your hands can ensure that you have
washed or scrubbed for 15 seconds.
Percent Compliance
May 2009 Hand Hygiene
100
90
80
70
60
50
40
30
20
10
0
Physician
Nurse
Respiratory Therapy
Before
patient
contact
After
patient
contact
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
Nov-07
Sep-07
Jul-07
HH Rate
May-07
Mar-07
Jan-07
Nov-06
Sep-06
Jul-06
May-06
Mar-06
Jan-06
Nov-05
Sep-05
Jul-05
May-05
Mar-05
Jan-05
HH Compliance Rate (%)
Children's Hospital Boston
Hand Hygiene (HH) Compliance
by Month, Jan 2005 - Sep 2009
Joint Comm Target
100
80
60
40
20
0
Creating a Hand Hygiene Culture:
Summary
•
•
•
•
Designate leaders and form a team
Establish a timeline
Educate, Educate, Educate
Observe hand hygiene practice and share
results
Creating a Hand Hygiene Culture:
Summary
•
•
•
•
•
•
Set goals and expectations
Start with small changes
Evaluate progress frequently
Make changes if something is not working
Highlight good practice
Celebrate your success!
Remember -- infection prevention
is in your hands
Resources
Hand Hygiene Websites:
•
World Health Organization
“Clean Care is Safer Care”
http://www.who.int/gpsc/en/
•
Centers for Disease Control and
Prevention
http://www.cdc.gov/handhygiene/
Acknowledgements
Patricia Hickey, PhD, RN, MBA, FAAN
VP, Cardiovascular/Critical Care Services
Michelle Lyden, MSN, NP, MPA
Quality and Safety Research Manager
Debra Morrow, BSN, RN, CCRN
CICU Infection Prevention Nurse
Gail Potter-Bynoe, BS, CIC
Manager, Infection Prevention & Control
Laura Helsing, MPH
Infection Prevention Epidemiologist
Jeanne Ahern, BSN, MHA, RN, CCRN
Nurse Manager, CICU
Aimee Lyons, MSN, RN, PNP, CCRN, NEBC, EMT
Director, MSICU & Critical Care Transport Program
Toni Saltamartini Imprescia, RN, CCRN
Clinical Educator, CICU
Jason Thornton, MSN, RN, CCRN
Nurse Manager, MICU
Kathy Jenkins, MD, MPH
VP, Patient Safety and Quality
Traci Wolbrink, MD
Chief Fellow, Pediatric Critical Care
Ann Petruzziello
Patient Services Education & Training Manager
Thank You
Questions?