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The Unit that Could: Searching for the
Lost Art of Hand Hygiene
Cardiac Surgery ICU Royal Columbian Hospital
Sue Brace, Patient Care CoordinatorMichael Arget, Infection Control Practitioner
Catherine O’Donnell, Quality Improvement/Patient Safety Consultant
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Raiders of “The Lost Art”
In search of the Lost Art of Hand Hygiene in healthcare
In late 2009/2010, hand hygiene compliance across FHA was well below 30%
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The Healthcare Jungle
Royal Columbian Hospital (RCH) is a 430 bed tertiary centre located in New Westminster, British Columbia.
RCH is the centre for Fraser Health Cardiac Services including: •Interventional Cardiology •Cardiac Surgery
Approx 840 open heart surgeries will be completed this fiscal year.
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Gathering the Expedition Team
Patient Care Coordinator and Infection Control Practitioner had a brief discussion on how to look at improving care in the CSICU.
Third Wave of the New Approach to Controlling Superbugs provided by Cdn Pt Safety Institute.
Surgical Healthcare Associated Infection Prevention Excellence Collaborative (SHAIPE) had been launched within FHA.
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Principles of Positive Deviance (PD)
• Community ownership
• Self – Discovery
• The people are the “experts”
• Immediacy of action
• Emphasis on practice
• On-going measurement reinforcing change
The Right Gear for the Journey
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To Recover “The Lost Art”
The Unit’s goals:
1. To increase Hand-hygiene compliance to 85% in CSICU by September 2011
X
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Our Strategy to capture “The Art”
Weekly huddles with staff to discuss barriers to providing great patient care
E-mail summary sent to all staff
Review 4 Moments of Hand Hygiene
Regular hand hygiene audits
PD Notice board on Unit: Audit Results, Tip of the Week
Use different engagement tools (PD Skits)
De-cluttering of unit
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The Trek to the Lost Art of Hand Hygiene
X
Base Camp
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Venturing into the Jungle
It was lonely in the beginning
Staff were unsure about these “huddles”
Concerned about speaking out
Staff couldn’t get away from the bedside
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Some Successes en route
Easy changes were made to the unit that improved work flow and awareness for staff including: • New corner shelving; computer
keyboard covers, removal of large garbage containers
• All gloves latex-free• New hypoallergenic soap
product• Install barrier cream dispensers• Signage (on soap bottles, hand
washing reminders for staff/visitors)
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The Trek to the Lost Art of Hand Hygiene
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Base Camp
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On the Way –Marshmallow break
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The Trek to the Lost Art of Hand Hygiene
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Base Camp
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More Successes:
“The Art” is within reach
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Hand Hygiene Audits
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Sep-11 Dec-11 Jan-12 Feb 4 2012 Feb 15 2012
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The Trek to the Lost Art of Hand Hygiene
X
Base Camp
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PDSA...The Scissors
Scissors became a major issue.
Used for patient care situations.
Removed scissors from bedside.
Tied them to bedside carts.
Discussed at Professional Practice
Council.
Back to initial practice with
modification.
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The Trek to the Lost Art of Hand Hygiene
X
Base Camp
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Falling into the Snake Pit
Over the summer, we took a break from huddles due to vacations, etc
Hand hygiene audits were not being done regularly
An audit in the fall showed HH compliance was at ~50 %
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The Need to Regroup
Met with the manager to discuss future steps…
Weekly HH audits
Frequent PD huddles
February was our target
month.
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The Trek to the Lost Art of Hand Hygiene
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Base Camp
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More Successes En Route
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What staff think about the Huddles
What do you like?
• Increased communication and awareness
of practice
• Involvement of multiple perspectives including QI & ICP.
What have you changed?
I am more conscious about 4 moments of HH
“I use way more Isagel”
“I am more comfortable telling others to wash their hands”
“Have A Squirt”
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Reflecting on the Ongoing Journey
Staff/Physician Engagement Successes have been due to:
Management Support
Commitment of Team
Consistency of huddles &
summaries
Regular audits
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The Art of Hand Hygiene is very elusive and it is difficult to achieve without focused efforts to change culture.
“The Art” will hopefully be within reach for CSICU with ongoing efforts from the unit.
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Questions & Answers
