Webcast: Hand Hygiene – not just for healthcare providers anymore!

WELCOME…. TO OUR WEBINAR

HAND HYGIENE…NOT JUST FOR HEALTHCARE PROVIDERS ANYMORE!

Our Panelists for today…

Anne MacLaurin, Patient Safety Improvement Lead, CPSI

Gina Peck, Project Coordinator CPSI

Jason Thompson, Communications Officer CPSI

Please write down your questions for the end of the presentation or put them in the chat box or in the Q&A box Slides for today’s presentation Today’s call will be recorded

Before we get started

Our partners: Our sponsor:

Thank you!

Be like Anne and Pat

Use #pledgecleanhands on social media Gallery of all the pledges online

I pledge to clean my hands. Do you?

Our Guest Speakers…

Jignesh Padia

Dr. Jocelyn Srigley

Josée Shymanski

Pat Malone

Jignesh Padia

Message from Patients for Patient Safety Canada

PATIENT EXPERIENCES Surgical Site Infections

Hi! My name is Jignesh Padia. What brings me to this session is our ongoing care episode for my 4 year old son and some of the very positive experiences we had during his spinal cord detethering surgery. Before surgery, we were very concerned about the infection. Especially because we learned that a spinal cord infection could easy result in serious condition affecting our child’s development and future. We are very thankful to entire Neurosurgery Team and all the staff at Stollery’s for providing a positive outcome for my son’s surgery.

Background

Summary of our surgical experience

What went well….. We were provided antimicrobial soap

for preoperative bathing at home.

We actively noticed rigorous hand hygiene by Neurosurgeons.

During post surgical follow-ups Neurosurgeon always sanitized their hands before touching or examining the wound.

Sanitizing hands in front of us as a parent gave us more confidence in the providers taking care of our son.

Potential opportunities…..

Instruction on how many times and how to use soap were verbal. A written instruction (one pager) could ensure that parents are able to follow instructions to the point for better outcome.

We had experienced that Nursing staff on the ward were less compliant and would even touch the wound without sanitizing hands after entering in the room.

Ward floor was only mopped once everyday and by the end of shift you could visually see dirt on the floor. There was an opportunity for things such as catheter lines and other probes to touch the floor and get contaminated.

Below pictures show what are some of the risks for patients and especially young kids who get infected post surgery.

Many factors could cause such infections and each step to prevent it becomes important.

In the below picture you are seeing a baby who got infected post surgery. The parents of this baby are Facebook friend of ours. They told us that they never got any soap or instruction to clean their baby before surgery.

Risks….

Risks….

Another Facebook friend, who also had not so positive outcome post surgery. Their baby required

multiple surgeries as a result of recurring infections.

Other stories from family friends…

Infection Post “C” section Person had elevated blood glucose

prior to going for “C” section.

No Antibiotic was given prior or immediately after the surgery.

Surgical wound got infected and now the mother is going through hardship while coping with new baby.

Most of her time is spent in appointments and follow-ups regarding this infection.

Death of pediatric Cancer Patients post surgery for “pic” lines There has been many known cases

were pediatric cancer patients died post surgery.

In many cases the inserted “pic” line or tube started the infection.

They are worried about infections and want to do their part – Ask for / Provide information about what they can do to prevent it

• Many times (at arrival, during care, etc), • Many channels (written, 1:1 conversations, etc), • Many voices (physician, nurse, patient advisors, cleaning staff)

– Ensure soap/ sanitizer and other equipment is available – Be a role model

• Wash/ clean your hands in front of the patients/providers • Explain why and how you do it • Ensure all staff follow the same processes

Patient/family needs

By participating in this important work, you have already shown the leadership. Please spread the surgical check list and its use to each

and every part of your organization. Promote best practices and most importantly hand

hygiene. Thanks for listening and being passionate about this

topic.

You can make the difference

Jocelyn Srigley

Hand Hygiene Related to Patients & Family

PATIENT HAND HYGIENE: WHAT’S THE EVIDENCE?

Jocelyn Srigley, MD, MSc, FRCPC Provincial Health Services Authority

Vancouver, BC

Outline

Does patient hand hygiene matter? – Evidence for transmission via patients’ hands

Do patients perform appropriate hand hygiene? – Data on patient hand hygiene rates

How do we improve patient hand hygiene? – Existing evidence for interventions

Evidence for Transmission from Patient Hands

Plausible routes of transmission Data on patient hand colonization Evidence that improving patient hand

hygiene decreases infection rates

Transmission via Patient Hands

Fecal-Oral Indirect Contact

Multidrug-Resistant Organisms on Patients’ Hands

357 patients admitted to 6 post-acute care facilities Baseline hand carriage:

– MRSA 10.9% – VRE 13.7% – Resistant Gram negative bacilli 2.8% – Any MDRO 24.1%

1Cao et al, 2016.

C. difficile Spores on Patients’ Hands

44 patients with C. difficile infection (CDI) or colonization 15 (34%) had positive hand cultures before

hand hygiene

2Kundrapu et al, 2014.

Systematic Review Results Author (Year) Study Design Study Setting Participating

Patients Recipients of Intervention

Elements of Intervention

Results: Healthcare Associated Infections

Results: Hand Hygiene Rates

Pokrywka (2014)

Before-after 520-bed tertiary care and teaching hospital

All inpatients Both Education, reminders, provision of product

CDI rate 10.45/ 10,000 patient days before to 6.95/ 10,000 patient days after; p=0.0009

N/A

Gagne (2010)

Before-after 250-bed community hospital

All inpatients Patients Education, provision of product

MRSA 10.6/ 1,000 admissions before to 5.2/1,000 admissions after

N/A

Cheng (2007)

Before-after Inpatient psychiatric department

Long-stay psychiatric patients

HCWs Provision of product

6 outbreaks affecting 66 patients (18.2%) before; 4 outbreaks affecting 23 patients (4.4%) after; p=0.005 for total patients involved

N/A

Thu (2007)

Controlled before-after

2 neurosurgical wards

Inpatients who had undergone a neurosurgical procedure

Patients Education, provision of product

SSI decreased from 8.3% to 3.8% on intervention unit and increased from 7.2% to 9.2% on control unit; p=0.04 for comparison between units

N/A

Hilburn (2003)

Before-after Orthopedic surgical unit

N/S Patients Education, reminders, provision of product

Nosocomial infection rate 8.2% before to 5.3% after

N/A

Peters (1992)

Before-after with repeated treatment

Maternity ward Postpartum women Patients Provision of product

Puerperal mastitis 2.90% before to 0.66% after; p<0.001

N/A

Outline



How do we improve patient hand hygiene? – Existing evidence for interventions

Indications for Patient Hand Hygiene

After toileting (after body fluid exposure) Prior to eating Before leaving their room After entering their room Before aseptic procedures

Self-Reported Hand Hygiene Rates

Emergency department patients reported hand hygiene after 62-88% of bathroom visits and after 13-41% of bedside urinal/bedpan uses

3Luz et al., 2011.

Direct Observation of Patients

“Covert observation” by junior doctors found hand hygiene performed by patients during 73% of meals4 Patient/visitor hand hygiene compliance was

67.5% after body fluid exposures and 50% after contact with patient surroundings5

Study on pediatric wards only found 1 child to observe, who had 100% compliance6

4Mattam et al., 2012. 5Randle et al., 2010. 6Randle et al., 2013.

Electronic Monitoring of Patients

Hand hygiene on a multi-organ transplant unit measured by a real-time locating system for 9 months

After using the bathroom – 29.7% of 12,649 bathroom visits

Before eating – 39.1% of 6,005 meal times – Ranged from 32.2% at breakfast to 45.9% at dinner – 3.3% of 1,122 kitchen visits

Room entry and exit – 2.9% of 5,786 entries and 6.7% of 5,779 exits

7Srigley et al., 2014.

Outline



How do we improve patient hand hygiene? – Evidence for interventions

Surgical Site Infections in Neurosurgery

Controlled before-after study 785 patients on 2 neurosurgical units in Vietnam Intervention

– Inpatients on 1 unit given ABHR and education Surgical site infections decreased from 8.3%

to 3.8% on intervention unit and increased from 7.2% to 9.2% on control unit (p=0.04 for comparison between units)

8Thu et al.

Mastitis on a Maternity Ward

Before-after with repeated treatment ~2300 postpartum women on a maternity ward in

Germany Intervention

– Patients provided with ABHR at bedside x 10 months, then withdrawn x 2 months and reinstated x 2 months

Puerperal mastitis decreased from 2.90% in controls to 0.66% in intervention patients (p<0.0001)

9Peters et al.

MRSA in a Community Hospital

Before-after study 250-bed community hospital in Quebec Intervention

– All inpatients given education and alcohol-based hand rub (ABHR) BID x ~1 year

Nosocomial MRSA rates decreased from 10.6/1,000 admissions in the year before to 5.2/1,000 during intervention

10Gagne et al.

Outbreaks on a Psychiatric Unit

Before-after study ~900 inpatients admitted to a psychiatric unit in Hong

Kong Intervention

– Staff gave ABHR to all patients Q4H during the day x ~1 year Decrease in nosocomial outbreaks during the

intervention compared to the year before – From 6 outbreaks affecting 66 patients (18.2%) to 4

outbreaks affecting 23 patients (4.4%) (p=0.005 for total patients involved)

11Cheng et al.

C. difficile in a Teaching Hospital

Before-after study 520-bed teaching hospital in the USA Intervention

– Education, reminders, and alcohol wipes on meal trays – Staff and volunteers encouraged to clean patient hands at

mealtimes – Added to an existing CDI “bundle”

CDI rate decreased from 10.45/10,000 patient days before to 6.95/ 10,000 after (p=0.0009)

12Pokrywka et al.

HAI Rates on a Surgical Unit

Before-after study Orthopedic surgery unit in the USA Intervention

– Patients given ABHR and education x 10 months – Posters reminded staff, patients, and visitors about

hand hygiene Nosocomial infection rate decreased from

8.2% in the 6 months before to 5.3% during intervention (p-value not reported) 13Hilburn et al.

Hand Hygiene at a Pediatric Hospital

Cluster randomized-controlled trial Children’s hospital in the UK Intervention

– 6 wards randomized to interactive educational activities using “Glo-Yo,” mobile learning technology, or control

Hand hygiene rates increased by 31.7% among intervention patients compared to 13.8% in control group (p<0.001)

14Lary et al.

Hand Hygiene at a Rehab Centre

Before-after study ~100 patients on 3 units of a rehab centre in Sweden Intervention

– Patients education and ABHR in bathrooms – Staff gave out alcohol wipes at mealtimes and were

encouraged to remind/assist patients with hand hygiene

Hand hygiene rates increased from “seldom” before intervention to 85% before meals and 49% after toilet use

15Hedin et al.

Hand Hygiene on Surgical Units

Before-after study ~160 inpatients on 3 surgical units in the USA Intervention

– Staff education followed by audits to assess whether they assisted patients with hand hygiene

Staff assisting with patient hand hygiene at 6 moments increased from 17.3% in the 6 weeks before intervention to 44.6% in the 6 weeks after (p=0.0003)

16Ardizzone et al.

Hand Hygiene After Commode Use

Before-after study 40 inpatients with mobility difficulties Intervention

– Hand wipe containers and reminder signs attached to commodes

Patient survey – Patients offered wipes some of the time increased

from 69% to 100% and all of the time increased from 50% to 85%

17 Whiller et al.

Summary of interventions

Targets – Patients (5/10) – Healthcare workers (HCWs) (3/10) – Both (2/10)

Components – Provision of product (8/10) – Education (7/10) – Reminders (3/10) – Audits (1/10)

Conclusions

Patient hand hygiene matters Patients do not perform enough hand

hygiene Interventions to improve patient hand

hygiene reduce HAIs, but quality of evidence is low – Intervention components have been similar to

healthcare worker hand hygiene programs

Josée Shymanski

Rapid Fire Presentation

PATIENT HAND HYGIENE

It’s just as important!

Josée Shymanski Hôpital Montfort, Ottawa, ON

May 5, 2016

Bonjour! Hello!

Follow me to see what Montfort is doing to promote patient hand hygiene!

Main entrance

Registration

Emergency

Short history

Patient teaching

Evaluation of the teaching session Survey (n=30)

1. Helpful? YES 100% 2. Washing your hands

more often? YES 60% 3. Asking others? YES

16.7% 4. Staff offering you

alcool gel? YES 3.3%

Comments Difficult to do by myself, immobilized, cannot reach, would like help

Pilot projet -hand hygine prior to meals

A. Distribution of alcool gel from a bottle by the patient care assistants

B. Distribution of disposable wipes from a container by the dietary staff

C. Distribution of disposable wipes from a container by the patient care assistants

Volunteer’s perspective

Before meals, we go from room to room and offer alcool gel to patients and help them wash their hands. Patients get use to this and often they will extend their hands towards us.

Patient care unit

Having someone assigned to helping patients set up for meals and wash their hands makes a big difference as staff is often very buzy. The presence of volunteers on the unit is greatly appreciated by patients and by the staff.

Patient’s perspective

When you are hospitalised, your routine if different from what you usually do at home; it’s easy to forget to wash your hands. It’s also harder to wash your hands when you are immobilised.

Mental health program

Attention : la cafétéria est maintenant ouverte pour le diner. SVP lavez-vous les mains à l’entrée. Bon appétit! Attention: the cafeteria is now open for lunch. Please wash your hands at the entrance. Bon appétit!

Next steps

1. Measure our performance. « Is staff encouraging you/helping you to wash your hands before meals? After going to the bathroom? » Goal: 80% YES, ALWAYS

2. Promote innovation, share succeses

3. Increase presence of volunteers on patient care units

Questions? [email protected]

mailto:[email protected]

Pat Malone

Rapid Fire Presentation

Saint Elizabeth’s Journey to Hand

Hygiene Excellence May 2016

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OUR STRATEGY

Staff Engagement Client Engagement System Innovation

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STAFF ENGAGEMENT

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STAFF ENGAGEMENT

S

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STAFF ENGAGEMENT

Sharing Results and Celebrating Success Newsletters Staff meetings Client Quality, Risk and Safety Committee Health and Wellness Advisory Committee

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CLIENT ENGAGEMENT

75

CLIENT ENGAGEMENT

AND PARTNERSHIP

CLIENT/COMMUNITY ENGAGEMENT

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Question of the Month:

Saint Elizabeth requires all of our staff to wash their hands or use hand sanitizer prior to providing any care to our clients. We want to make sure that our staff are complying with this policy 100% of the time, and that our clients feel confident in our staff’s hand hygiene practices. How can we make our hand hygiene practices the best they can be?

SYSTEM INNOVATION

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SYSTEM INNOVATION

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SYSTEM INNOVATION Celltrak task added to every visit.. What is the

most important thing I can do for you today? at is the most important thing I can do for you today?

Mark it as √ Completed Don’t forget to inform the client!

Wash Hands and Inform Client

SYSTEM INNOVATION

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A

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Measurement Region/Nursing

January 2016

Active Visits % Compliance –

Q-wash

Q3 NRC Survey N Size

Top Box Only

CENTRAL 18834 99.9 123 80.5

CENTRAL EAST 10182 99.9 54 85.2

CENTRAL WEST 7528 99.7 185 84.3

CHAMPLAIN 7038 99.8 106 77.4

ERIE-ST. CLAIR 8478 100.0 57 91.2

HNHB 11044 98.4 114 81.6

MISSISSAUGA-HALTON 8127 99.9 47 80.9

SIMCOE-MUSKOKA 5554 100.0 96 89.6

SOUTH EAST 5360 99.8 105 84.8

SOUTH WEST 11080 99.8 62 83.9

TORONTO CENTRAL 13539 100.0 33 85.1

WATERLOO-WELLINGTON 2673 100.0 82 75.6

WHAT WE HAVE LEARNED

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Partner with clients Engage and involve staff – so that the campaign is their

own Keep it active and obvious be ‘kindly and respectfully’

relentless Measure and communicate, communicate, communicate Don’t stagnate – keep it fresh

caoncontact

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QUESTIONS

Use #pledgecleanhands on social media THANK YOU FOR ATTENDING!!

I pledge to clean my hands. Do you?

Webcast: Hand Hygiene – not just for healthcare providers anymore!

Healthcare

Transcript of Webcast: Hand Hygiene – not just for healthcare providers anymore!