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…atleastItry

¤ 24hospitalsintheNL(ICUs&surgery)

¤ 19%overallcompliance

² 3%before² 22%aGer

¤ NodifferencebetweenRNenMD

¤ SmallerhospitalsbeOerthanbigger

VickyErasmusInfControlHospEpidemiol2009

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¤ Welook,othersdon’t…¤ Oursurveillanceistoogood(noHawthorneeffect)…

¤ NoonecandobeOer…¤ FiveindicaYonsare(two)toomany…

¤ Handhygieneisonlyoneofthemeasures…

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Source:HealthProtecYonScotland,January2013

Theyareboth(orthecar,willbesoon)full-of-sh…

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hOp://www.hha.org.au/LatestNaYonalData.aspx

Whydon’ttheylistentoInfecYonControl?

Policing One-trackmind

Guidelines

Guidelines

Guidelines

Guidelines

Moreguidelines

…&moreESBLCREMRSAMDR-ABXDR-TBPRPMERS-CovC.difNoroFluLA-MRSACNR-GNRSARSFungiCR-ESCOCA-MRSATBC…

Please,nomore!

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ICneedstobeto-the-point

MRSA

ESBL

C.dif&Co

CRE

…..

HAI-prevenYon

CommunicaYon

¤ Structure&design¤ Knowwhy¤ Learningfromothers

¤ Structure&design¤ Knowwhy¤ Learningfromothers

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¤ IntuiYve

¤ Clear

¤ SeducYve

¤ Force?

¤ Award

Mirrorinelevator

² Moreroom

² Changeofbehavior

¤ Structure&design¤ Knowwhy¤ Learningfromothers

StandardHospital

Weareagreathospital

Gooddoctors,Caringnurses…

Trustus!

We“care`’aboutthephysicalandmentalhealthofourpaYents

Wedosobyensureeasy

access,onestopshop,andahealing

environment

Whichhappenstomakeusagreat

hospital.Trustus?

YourHospital

Why

How

What

ComputerCompanyX

Wemakegreatcomputers

BeauYfuldesign,userfriendly…

buyone?

EverythingwedoWebelieveinchallenging

thestatusquo,webelievein

thinkingdifferentlyWedosobymakingourproducts

beauYfuldesigned,anduserfriendly

Whichhappenstomakegreatcomputers.Buyone?

Apple

Why

How

What

Others

Disinfectyourhands

UseABHRDoit!

Wewanttoimplementefficientand

effecYvewaystoincreaseourpaYentssafety

WeplacedABHRatthepointofcareforyouruse

Highcompliance=paYentssafety

You

SimonSinek’sGoldenCycle

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¤ NevertrieditforInfecYonControl ² your“missionstatement”couldbeconstructedlikethis² Writeitonyourwalls,screensavers,…

² usewhenteaching² usewhenarguingwiththosenon-compliant

² useinpaYentfolder

¤ Structure&design¤ Knowwhy¤ Learningfromothers

¤ High-riskindustries² commercialaviaYon² oilandgasindustry

¤ MarkeYng

¤ Behavioralscience

¤ Media

AlmostGood,MD

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…thepilotwillbeamongthedead

• Education

• System change

• Motivation

Youdoagreewithmethatwedon’twantawide-spreadepidemic,don’tyou?

firstMRSAisolatewasrecoveredwithin72hofICUadmission

firstMRSAisolatedaGer72hofICUadmissionP<0.01

Pre-SARS Post-SARS

SARS

ClinInfectDis2004;39:511-516

PaYentinvolvement:…theycannotandshouldnotberesponsiblefortheirownsafetyinanenvironmentoverwhichtheyhavenocontrol

George Annas NEJM 354;19:2063-2066

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•  89%ofthephotosdisplayingdoctorswere

incorrect•  31%ofthephotosdisplayingnurseswere

incorrect•  Itseemsthatthestereotypeimageofa

doctordoesnotagreewiththecurrenthandhygieneguidelines.

•  IfweaimforhighercompliancerateswithICmeasures,weneedtochangethesocialimageofHCWs

¤ PresenYngsomethingnewandimproveddoesnotautomaYcallychangebahavior!

¤ ‘ThelessonfrommarkeYngisthatpeoplearemorewillingtochangetheirbehaviourwhentheyfeelgood,flaOered,challengedpowerful,sexyorproud,thanwhentheyarefloodedwithfacts’(Hodgkin1999)

Onya,theRedskinscheerer(whoaskedthatherlastnamebewithheld,ciYngteampolicy),hasherpictureontheteam'sWebsiteinherofficialbikini-likeuniformandalsoreclininginanactualbikini.Onya,27,whodeclinedtoidenYfythecompanysheworksfor,isbutoneofseveraldrugrepresentaEveswhohavecheeredfortheRedskins

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Thusneveragainsaythatthe

majoritydoesn’tcomplywithIC

Aschconformityexperiments

¤ DoesbeOerpaymentleadstomoreeffort

¤ 600peoplewalkingbywereaskedtohelpunloadingasofafromatruck² GroupA:“justasked”² GroupB:“offered50centahead”² WillingnesstohelpingroupBsignificantlylower

² WillingnessofgroupBonlycomparabletogroupAat$5

¤ Praise>>Money,andwecannotaffordtopayforbeOercompliance

HeymanJ,ArielyD.PsycholSci2004;15:787-793

www.sciencexpress.org/20November2008/Page1/10.1126/science.1161405

§ Orderlyalley:33%liOering§ GraffiYalley:§ 69%liOering

¤ whenpeopleobserveinappropriatebehavior,thisweakenstheirconcernforappropriateness

§ Orderlyalley§ NograffiYsign§ Flyeronhandlebar§ avoidliOering

Weneed“order”inourhospitalsandpeopleshowingappropriatebehavior!

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¤ AninnocentassociaYonwitheitherbadorgoodthingswillinfluencehowpeoplefeelaboutusoraproduct² Thegoodlookingmodelsnexttothecar² RaYngofidenYcalcarchangedwithandwithoutmodel

² Mendidn’tbelievethattheirjudgmentwasinfluenced

§  Culture change (CEO directive and save/open communication)

§  State your motivation (“why”) §  Better design §  Patient’s involvement §  Media support §  A (supportive) inspectorate