patient safety starts with me! baylor health care system hand hygiene initiative 2008 - 2010 irving...

PATIENT SAFETY STARTS

WITH ME!

Baylor Health Care SystemHand Hygiene Initiative

2008 - 2010Irving Prengler, M.D., M.B.A.

Chief Medical OfficerBaylor University Medical Center

Baylor UniversityMedical Center

Baylor UniversityMedical Center Statistics

• 37,238 admissions (including newborns) • 4,298 babies born • 56,570 emergency room visits • 254,382 outpatient visits(excluding home care and

emergency department) • 1200 licensed beds • 1,250 physicians with active privileges • 185 medical residents and fellows • 5,225 employees

Baylor Health Care System

• 23 owned, leased, affiliated and short-stay hospitals

• 88 primary care centers, specialty care centers, senior health centers

• 12 rehabilitation clinics • 17 ambulatory surgery centers • Baylor Research Institute • ODC Therapy, Inc.•  

Baylor Health Care SystemFiscal Year 2008 Statistics*

• 109,881 admissions • 15,427 babies born • 310,535 emergency department visits • 556,577 outpatient registrations (excluding

emergency department and home care visits) • 2,955 average of licensed beds • 18,000 employees • 2,886 physicians on active staff

PATIENT SAFETY STARTS

WITH ME!

Hand Hygiene

Hand Hygiene is the single most

effective intervention to reduce the

cross transmission of healthcare

associated infections

PATIENT SAFETY STARTS

WITH ME!

Hand Hygiene

Why Measure Hand Hygiene?• Hands are the most common single source of

HAI’s• Nationally, compliance for handwashing for

HCW’s is only 40-60%• Hand hygiene reduces transmission of

infections by HCW’s• Many quality improvement and consumer

groups are demanding better performance from hospitals

Hand Hygiene Pioneers

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• Oliver Wendell Holmes• 1840’s in U.S.

• Ignaz Semmelweiss• 1840’s: General Hospital of

Vienna• First Clinic: Doctors and

medical students• Second Clinic: Midwives

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Hand Hygiene

Barriers to Hand Hygiene

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Hand Hygiene

• Lack of active participation at individual or institutional level

• Lack of role model for hand hygiene

• Lack of institutional priority for hand hygiene

• Lack of administrative sanctions of noncompliers and/or rewarding compliers

• Lack of institutional safety environment.

PATIENT SAFETY STARTS

WITH ME!

Hand Hygiene

Healthcare Organizations withSuccessful Programs

• Novant Healthcare System

• Cedars Sinai Hospital

• Massachusetts General Hospital

• Bronson Methodist Hospital

• Canada

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Hand Hygiene

BHCS HH Committee Members

• CEO BHCS• CNO BHCS• CMO BHCS• VP Quality BHCS• ID Physicians• Public Relations – BHCS• Nursing Directors• Infection Preventionist• Environmental Services• Chief Nursing Officers

Facility Based Hand Hygiene Teams

• ID Physicians• General/Surgery Physicians• Nursing leadership • Infection Preventionist• Bed side Nurses• EVS• RT• PT• OR• Etc

Hand Hygiene InitiativeCommittee/Team Formation

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WITH ME! Hand Hygiene

• Steering committee– Operations– Marketing/Public Relations– Education

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AIM Statement To increase the Baylor Health Care System hand

washing compliance from the current rate to 85% by the end of June, 2009 and 95% by the end of June, 2010, thereby contributing to a projected 10% decrease in the number of healthcare associated MRSA infections, urinary tract infections, and central venous catheter associated bloodstream infections by the end of June, 2009 and 20% by the end of June, 2010.

Hand Hygiene

PATIENT SAFETY STARTS

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Hand Hygiene

Hand Hygiene Initiative MetricsIndication Sample Size Methodology Metric

Central line infections

All population MedMined Rate/1000 line days

Urinary tract infections

All inpatients MedMined Rate/100 admissions

MRSA infections

All inpatients MedMined Rate/100 admissions

Hand Hygiene

At least 30

observ./month

Observation Compliance rate/100 observ.

3 Phases of the Campaign

• Awareness/Education

• Engagement

• Accountability

PATIENT SAFETY STARTS

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Hand Hygiene

Hand Hygiene CommitteeRecommendations

• Develop non-verbal ways of communicating non-compliance

• Make hand hygiene products readily available

– Kiosks at entrances, floors

– Small promotional products for personal use

Hand Hygiene CommitteeRecommendations

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Hand Hygiene

• Distribute hand hygiene education posters throughout the institutions

• Develop reward system for compliance

• Develop education “flip and tell” for employees

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Hand Hygiene

• In-service education

• Information leaflets

• Workshops and lectures

• Automated dispensers

• Performance feedback on adherence rates

• Patient/family involvement

• Accountability

Methods Used to Promote Improved Hand Hygiene

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WITH ME! Hand Hygiene

Areas to Implement • Handwashing

– Soap and Alcohol– Conveniently available everywhere– Everyone washes every time– Get patients involved

Teach patients to say: “Please wash your hands before you touch me or any of my catheters.”

Awareness/Education Phase

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Hand Hygiene

Oliver Wendell Sutker 1840FOAM

INFOAM

OUT

Patient InvolvementHand Hygiene

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Other Awareness / Education Resources

• CDC Hand Hygiene Video placed on BTV in English and Spanish

• Flip and Tell – Power Point Education

2009 Infection Prevention RetreatZero Tolerance for Infection: A Winning Strategy

February 2009• Healthcare Associated Infections• Change One Thing-Change Everything- The Power of One –

Victoria Nahum• MedMined Introduction• Hand Hygiene Campaign and Best Practice• VAP and Best Practice• CL-BSI and Best Practice• SSI and Surgical Care Improvement Project• Clostridium Difficile Infection• CA-UTI and Best Practice

• The two Hand Hygiene Campaign stories appearing in the July Baylor Progress online microsite at the launch of the campaign were the two most viewed stories that month with 655 and 609 views respectively.

• The myBaylor.com Hand Hygiene page has received more than 5,000 hits

since being posted in July.

• Joel Allison’s video hand hygiene message to employees and physicians has been viewed online 663 times since August 1.

• Patient Safety Tips posters that include a message about good hand hygiene are going up in all 3,000 patient rooms.

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Hand Hygiene

Hand Hygiene Information for Infection Prevention Summit

Engagement Phase

Taking it to the next level

• More patient and family involvement

• Continue strong marketing effort

• Maintain collegiality with firm expectations that everyone follows our policy

• Empowerment

• “Stop the line”

Hand HygienePATIENT SAFETY STARTS

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You Bugged Me Card

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Handwashing Compliance

Observations % Compliant % Non- Compliant

MD 153 37% 63%

Nurse 842 75% 25%

Unit Tech 360 81% 19%

EVS 69 87% 13%

PT 73 82% 18%

Pharmacy 18 94% 6%

Social Wkr 10 60% 40%

Resp Therapy 42 69% 31%

Nutrition 14 79% 21%

Transport 60 43% 53%

BUMC-Hand Hygiene Total Compliance Rate

7/08 to 11/08 - 79.581%

7/08 to 2/09 – 79.955%

Per 100 observations

20,542 observations

Top HH Compliance Rates

• BMTU 91.234• GI LAB 91.071• 3/CCU 87.697• 8R 86.977• 2R So 85.366• L & D 84.266• 4T 84.104• 4N 83.123• 3H 82.727• 4W 82.647

Bottom HH Compliance

• 3T 63.3335• 5H PACU 66.667• 6T 72.27• ED 72.7822• 13R 74.114• 5J 75.238• 14R 75.484• 2J 75.5• 10R 75.537• 2TW 75.907

Accountability Phase

Accountability

• Hand Hygiene Goals have been developed for the system – Attached to performance appraisals– Cascaded down to all staff

• Physician names are taken during audits– Physician receive letter from leadership– Chief receives letter if continues non compliance

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Hand Hygiene

Hand Hygiene InitiativesConclusions

• Need Leadership engagement• Healthcare workers hand hygiene compliance must be

hardwired.• Hand hygiene can be improved with a concentrated effort• A variety of motivators are needed to reach all types of

people• A substantial auditing program is required to measure

performance• All staff must be accountable

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Hand Hygiene

• The evidence is compelling that action taken to invest in prevention can have a profound positive impact on the organization’s bottom line, patients’ safety and satisfaction, and reputation

APIC Briefing 2007

Infection ControlThe Business Case

Ignaz Prengler

The Real Reason It’s the right thing to

do for the patients we serve

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Hand Hygiene