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TRANSCRIPT
In the United States, one in 136 hospital patients become seriously illas a result of acquiring an infection in the hospital. This is equivalent totwo million cases a year.
And the costs…..“the overall annual direct medical costs of HAI to U.S.hospitals ranges from $28.4 to $45 billion.. the benefits of preventionrange from a low of $5.7 to $6.8 billion to a high of $25.0 to $31.5 billion.”R. Douglas Scott II, Economist, Division of Healthcare QualityPromotion, CDC, March 2009
“ ”“Every day, 247 people die in the USA as aresult of a health care-associated infection."This is equivalent to a 767 aircraft crashingevery day or more than 90,000 deaths annually.”
World Health Organization
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Why Hand Hygiene?
WHO Guidelines on Hand Hygiene in Health Care
Health Care Associated Infections (HAI) affect hundredsof millions of people worldwide and are a major globalissue for patient safety.
“Yet hand hygiene improvement is not a new concept…long lasting improvements remain difficult to sustain……”WHO, Guide to Implementation of the WHO MultimodalHand Hygiene Improvement Strategy
Hand Hygiene Project: Participating Hospitals’Characteristics and Project Details
*Implemented throughout hospital
Cedars-Sinai California Yes 950 x xHealth System
Exempla LutheranMedical Center Colorado No 400 x*
Froedtert Hospital Wisconsin Yes 486 x
The Johns Hopkins Maryland Yes 1,041 x xHospital
Memorial Hermann Texas No 252 x xThe Woodlands
Trinity Health - St. Joseph Michigan Yes 537 xMercy Hospital
Virtua - Memorial New Jersey No 270 x x x
Wake Forest North Carolina Yes 872 x xUniversity BaptistMedical Center
Hospital Location Teaching Number Medical Intensive Otherhospital of Beds Surgical Care Unit
Pilot Sites
Hand Hygiene Measures: Expectationsvs. Reality; Solutions Impact
May
March
Janu
ary '1
0
Nove
mbe
r
Septe
mbe
rJu
lyMay
March
Janu
ary
100%
90%
80%
70%
60%
50%
40%
30%
Date
Co
mp
lian
ceP
erc
en
tag
e
January October
Hand Hygiene Compliance (Aggregated)
Hand hygiene complianceimprovement in pilot sites
How The Future Must Look
Baseline Reality;Low Compliance &High Variability
Similar findings from WHO Pilots
50454035302520151051
50
45
40
35
30
25
By Day Time Series
%H
an
dH
yg
ien
eC
om
plia
nce
Hand Hygiene Performance at Sample Hospital Unit
WhereWe
ThoughtWe Were
SolutionsBeginning
Main Causes of Failure to Clean Hands(across all participating hospitals)
Ineffective placement of dispensers or sinks
Hand hygiene compliance data are not collected orreported accurately or frequently
Lack of accountability and just-in-time coaching
Safety culture does not stress hand hygiene at all levels
Ineffective or insufficient education
Hands full
Wearing gloves interferes with process
Perception that hand hygiene is not needed ifwearing gloves
Health care workers forget
Distractions
Note that not all of the main causes of failure appear in every hospital. The chart above representsthe validation of the root causes across hospitals. This underscores the importance ofunderstanding hospital-specific root causes so that appropriate solutions can be targeted.
A B C D E F G H
Main Causes of Failureto Clean Hands(across all participating hospitals)
Ineffective placementof dispensers or sinks
Hand hygiene compliancedata are not collected orreported accurately orfrequently
Lack of accountability andjust-in-time coaching
Safety culture does notstress hand hygieneat all levels
Ineffective or insufficient education
Hands full
Wearing gloves interfereswith process
Perception that hand hygieneis not needed if wearing gloves
Health care workers forget
Distractions
x x x x x
x x x x x
x x x x x x
x x x x x
x x x x x
x x x x x x
x x x x x
x x x x x x
x x x x
x x x x
Identifying Causes, Targeting Solutions
SolutionsHand Hygiene compliance data arenot collected or reported accuratelyor frequently
Safety culture does not stress handhygiene at all levels
Ineffective placement of dispensersor sinks
Hands full
Causes• Data provide a framework for a systematic approach forimprovement
• Utilize a sound measurement system to determine the realscore in real time
• Scrutinize and question the data• Measure the specific, high-impact causes of hand hygienefailures in your facility and target solutions to those causes
• Make washing hands a habit – as automatic as lookingboth ways when you cross the street or fastening your seatbelt when you get in your car
• Commitment of leadership to achieve hand hygienecompliance of 90+ percent
• Serve as a role model by practicing proper hand hygiene• Hold everyone accountable and responsible – doctors,nurses, food service staff, housekeepers, chaplains,technicians, therapists
• Provide easy access to hand hygiene equipment anddispensers
• Create a place for everything: for example, a health careworker with full hands needs a dedicated space wherehe or she can place items while washing hands
Habit• Always wash in and wash out upon entering/exiting a patient care area and before and afterpatient care
• Make washing hands a habit – as automatic aslooking both ways when you cross the street orfastening your seat belt when you get in your car
Active Feedback• Coach and intervene to remind staff to washhands
• Clearly state expectations about when tosanitize hands to all staff members
• Communicate frequently – provide visiblereminders and ongoing coaching to reinforceeffective hand hygiene expectations
• Engage staff – real time performance feedback• Tailor education in proper hand hygiene forspecific disciplines
• Provide just-in-time training• Use technology-based reminders and realtime feedback
• Celebrate improved hand hygiene
No One Excused• Protect the patient and theenvironment – everyone must wash in andwash out
• Make it comfortable to wash hands with soapor use waterless hand sanitizer
• Identify proper hand hygiene as anorganizational priority andperformance expectation
• Hold everyone accountable and responsible– doctors, nurses, food service staff, house-keepers, chaplains, technicians, therapists
• Apply progressive discipline from the top –managers must hold everyoneaccountable for proper hand washing
• Commitment of leadership to achievehand hygiene compliance of 90+ percent
• Serve as a role model by practicing properhand hygiene
Data Driven• Data provide a framework for a systematicapproach for improvement
• Utilize a sound measurement system todetermine the real score in real time
• Use trained, certified independent observersto monitor appropriateness of hand hygiene
• Scrutinize and question the data• Measure the specific, high-impact causesof hand hygiene failures in your facilityand target solutions to those causes
Systems• Focus on the system, not just on people• Make it easy; examine work flow ofhealth care workers to ensure ease ofwashing hands:• Provide easy access of hand hygieneequipment and dispensers
• Create a place for everything:for example, a health care workerwith full hands needs a dedicatedspace where he or she can placeitems while washing hands
• Limit entries and exits from apatient’s room – make suppliesavailable in room and eliminatefalse alarms that require staff toleave room to turn alarm off
• Identify new technologies to make it easyfor staff to remember to wash hands,i.e. radio frequency identification, automaticreminders, warning systems, real timescoring
EffectiveHygiene is inOur HANDS