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VA Hand Hygiene Improvement Project: Improving Hand Hygiene by Using Targeted Solutions

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Metrics of hand hygiene (HH) compliance based on WHO/CDC HH recommendations determined by blinded reviews were compared before and after implementation of Just In ... – PowerPoint PPT presentation

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Title: VA Hand Hygiene Improvement Project: Improving Hand Hygiene by Using Targeted Solutions


1
VA Hand Hygiene Improvement Project Improving
Hand Hygiene by Using Targeted Solutions Tool
(TST)
  • Infection Prevention
  • Medicine Service
  • Nursing Service
  • Volunteers

Joint Commission Center for Transforming
Healthcare
2
Disclosures
  • The views expressed in this presentation are
    those of the authors and do not necessarily
    represent the views of the Department of Veterans
    Affairs or the University of Texas Health Science
    Center at San Antonio.
  • I have a small IIR grant from Pfizer to study
    clinical outcomes of coccidioidomycosis.

3
Hand Hygiene Why is it important?
  • 1846 Ignaz Semmelweis
  • Mothers of babies delivered by students and
    physicians had a higher mortality rate.
  • Mothers of babies delivered by midwives had a
    lower mortality rate.
  • Physicians practiced autopsies, and delivered
    babies
  • When using antiseptic solution for hand hygiene,
    mortality drop
  • Doctors were offended they should wash their
    hands.
  • Semmelweis- died alone in an asylum, age 47.

CDC. Guideline for Hand Hygiene in Health-Care
Settings. MMWR 2002 51No. RR-16
4
  • An estimated 2 million patients get a
    hospital-related infection every year and 90,000
    die from their infection. Centers for Disease
    Control and Prevention
  • (Hand washing) gradually became accepted as one
    of the most important measures for preventing
    transmission of pathogens in health-care
    facilities
  • NPSG 07.01.01 Comply with HH guidelines

CDC. Guideline for Hand Hygiene in Health-Care
Settings. MMWR 2002 51No. RR-16
5
The problem
  • Discrepancy between peer review and blinded
    review HH observations in acute care at ALM
    Hospital

6
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7
Setting
A 256 bed VA acute care hospital, affiliated
with UTHSCSA
8
Team Members
  • Medical service Infectious Diseases and Hospital
    Epidemiology
  • Nursing Nurse Managers, Nursing Staff
  • Leadership Hospital Director, Chief of Staff,
    Nursing Leadership
  • Quality improvement Infection Prevention and
    Control Staff
  • Volunteers Healthcare students

9
Goal
  • To improve HH compliance by changing the culture
    of patient safety

10
Cause and Effect Diagram
11
Center for Transforming Healthcare
Mission to transform healthcare to high
reliability
12
What is Targeted Solutions Tool (TST) ?
  • A powerful process improvement tool that guides
    health care organizations through a step-by-step
    process to
  • Accurately measure their organizations
    performance
  • Identify their barriers to excellent performance
  • Direct them to proven solutions that are
    customized to address their particular barriers.

13
Participating Hospitals
  • Memorial Hermann
  • NY-Presbyterian
  • North Shore-LIJ
  • Northwestern
  • OSF
  • Partners HealthCare
  • Stanford Hospital
  • Trinity Health
  • Virtua
  • Wake Forest Baptist
  • Cedars-Sinai
  • Cleveland Clinic
  • Exempla
  • Fairview
  • Froedtert
  • Intermountain
  • Johns Hopkins
  • Kaiser-Permanente
  • Mayo Clinic

14
Effective HH is in our HANDS
  • Habit- as automatic as looking around before
    crossing the road Gel in, Gel out
  • Active Feedback- Coaching, Voice expectation to
    all staff, Engage staff, Frequent communication,
    Celebrate improvement
  • No One is Excused- Protect the patients, Hold
    everyone accountable, Commitment, Role modeling,
    Apply progressive discipline from the top
  • Data Driven
  • Systems- Focus on the systems, not the
    individual.

15
Steps to Implementation
  • Notification of key stakeholders.
  • Training of blinded (unbiased) HH reviewers
  • Six college students in health care career fields
  • STVHCS Infection Prevention Hand Hygiene Training
    Module.
  • Inter-rater agreement between HH trainer and
    student was validated (k1).
  • Selection of Pilot Unit 5A, 24 beds.
  • Just in Time (JIT) Coaches
  • Scripts were used to actively intervene when hand
    hygiene non-compliance is observed and to
    understand contributing factors to non-compliance
  • Healthcare workers are coached and encouraged to
    practice safe patient care
  • Establishment of timeline

16
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17
Aim statement
  • To improve HH compliance on an inpatient medicine
    unit at ALMD by 30 using the Joint Commission
    Targeted Solutions Tool hand hygiene
    methodology over a six week period.

18
Measure of success
  • Metrics of hand hygiene (HH) compliance based on
    WHO/CDC HH recommendations determined by blinded
    reviews were compared before and after
    implementation of Just In time Coaching.

19
Quality Improvement Tools and Results
20
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21
Comparison Chart by Profession
22
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23
Comparison of Hand Hygiene (HH) Compliance Before
and After HH Project
69/183
There was a 43 improvement in HH compliance on
Unit 5A after implementation of HH Project (p
lt.0001).
Joint Commission Targeted Solution Tool for Hand
Hygiene (unbiased reviewers , Just In Time
Coaches, analysis of contributing factors.)
24
Results
  • 44 increase in hand hygiene compliance from 38
    to 82.
  • Top three contributing factors
  • Distractions
  • Perceptions of need
  • Frequency of entrance/exit.
  • Healthcare workers perceived that hand sanitizer
    was not required prior to donning gloves.

25
Cost Avoidance
  • A 1 improvement in HH compliance savings of
    approximately 39,650 a year in a 200 bed
    hospital by mathematical modeling.
  • Taking into account an increment of 43 in HH
    compliance, savings of 204,504 a year in MRSA
    transmission prevention alone is projected.

Cummings, Anderson, Kaye,Infection Control and
Hospital Epidemiol 201031357-364
26
Conclusions
  • JIT coaching was associated with improvement in
    hand hygiene compliance.
  • Distraction was the key contributing factor for
    noncompliance.
  • Healthcare workers identified that they did not
    recognize hand hygiene was needed prior to
    donning gloves, a misperception.

27
Next steps
  • The project will be extended to other acute care
    units, including surgery and hemodialysis.
  • Solutions to contributing factors are being
    explored in greater depth.
  • One solution that is being considered for
    implementation is a patient education program It
    is okay to ask. to address factor of
    distraction.

28
References
  • The Joint Commissions Targeted Solutions Tool,
    Joint Commission Center for Transforming Health
    Care, retrieved 9/12/2011
  • http//www.centerfortransforminghealthcare.org/se
    rvice
  • CDC. Guideline for Hand Hygiene in Health-Care
    Settings. MMWR 2002 51No. RR-16
  • Cummings, Anderson, Kaye,Infection Control and
    Hospital Epidemiol 201031357-364
  • WHO Guidelines on Hand Hygiene in Healthcare,
    2009. Available athttp//whqlibdoc.who.int/public
    ations/2009/9789241597906_eng.pdf Accessed
    10/4/2011
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