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‘Nu prin mainile mele' Debbie XuerebSenior IPCNMater Dei HospitalMALTA@XuerebDdeborah-maria.pace@gov.mt
2
Mater Dei Hospital (MDH)
Mater Dei Hospital
❖ Only tertiary care hospital in Malta: 1000 beds
❖ Intensive care, transplantation, renal dialysis, maternity etc
❖ Infection Control Department
❖ One full time infection control doctor
❖ Infection control nurses: 4½ fulltime equivalent
❖ Epidemiologist, antibiotic pharmacist, surveillance officer
Nov 2007: Migration from old hospitalSt Luke’s Hospital (SLH)
Hand hygiene points: SLH vs MDH
St. Luke’s
Hospital
Mater Dei
Hospital
No hand hygiene improvement after migration!
0
10
20
30
40
50
60
70
80
90
100
Ward 1 Ward 2 Ward 3
2007: pre-migration 2008: post-migration
Co
mp
lia
nce
%
MRSA bacteraemia - 2008
Davey PG et al “Overview of strategies for overcoming the challenge of antimicrobial resistance”
Expert Rev. Clin. Pharmacol. 3(5), 667–686 (2010)
Hand Hygiene Strategy
WHO multimodal strategy used as guidance
Political Endorsement
❖ October 2008: Health Minister signs WHO pledge
❖ Press conferences, press releases
5 Moments concept introduced
Multimodal strategy
❖ Consists of several elements implemented in an integrated way to guide action and provide a clear focus for the implementer
❖ Targeting only ONE area, is highly likely to result in failure.
❖ All five areas should be considered, and necessary action taken, based on the local context and situation informed by periodic assessments
5 elements for IPC multimodal strategy
Build it – Systems change
❖ What infrastructures, equipment, supplies and other resources are required to implement the intervention?
❖ Does the physical environment influence health worker behaviour?
❖ How can ergonomics and human factors approaches facilitate adoption of the intervention?
.
Infrastructure
Alcohol handrub bottles
❖ At ward entrances
❖ At the foot of every bed
Standardised Sinks
Hand hygiene Products❖ Specifications for hand liquid soap, alcohol hand rub
and hand moisturisers, paper towels updated to minimize the possibility of procurement of poor quality products
❖ Infection control involved in every adjudication board related to hand hygiene tenders
❖ User evaluation introduced using modified WHO form
Training & Education
❖ Who needs to be trained?
❖ What type of training should be used to ensure that the intervention will be implemented in line with evidence-based policies and how frequently?
❖ Does the facility have trainers, training aids, and the necessary equipment?
Policy Development
❖ A reference for staff
❖ Spells out the standards expected by the hospital
❖ Covers principles of hand hygiene
Formal education
Include hand hygiene training in undergraduate university courses:
❖ Faculty of Health Sciences (nurses & allied health)
❖ Faculty of Medicine & Surgery (doctors, dentists, pharmacists)
❖ Yearly post graduate IPC certificate course for nurses
❖ Regular educational sessions organised by ICU for hospital staff, volunteers, cleaners, care assistants
❖ Continuous is not a mandatory requirement or linked to employment/pay
Annual infection control conferences
Monitoring and Feedback
❖ How can you identify the gaps in IPC practices in your setting to allow you to prioritize your intervention?
❖ How can you be sure that the intervention is being implemented correctly and safely, including at the bedside?
❖ How and when will feedback be given to the target audience and managers?
“If you do not measure it, you cannotimprove it”Lord Kelvin, 1824-1907
"To measure isto know"
Set Realistic, Achievable Targets
Hand Hygiene
❖ One of Key Performance Indicators (KPI)
❖ Minimum target by end of year: 50% compliance
❖ Audits + compliance reports to management
Hand hygiene Audits
❖ Direct observations using WHO audit tool
❖ Monitoring of alcohol handrub consumption
❖ Audit by profession
❖ 100 – 150 observations/ward
❖ ICNs and a part time assistant trained to carry out audits
❖ Give timely feedback
Auditing tools
www.hha.org.au
Audit results Feedback❖ Performance feedback to CEO, senior nurse managers and
medical doctor chairpersons
❖ Results disseminated to frontline healthcare professionals
❖ Action points identified for improvement
❖ Asked to indicate what support they need to improve
❖ Follow up meeting to assess if improvement was achieved
Speak a language they understand
❖ Provide Facts (Data)
❖ Published evidence
❖ Comparisons – how are we versus other units? Other Professionals?
❖ Turn data into meaningful, easy to understand information
Annual Awards
1. Highest compliance2. Best improvement3. Best role model/s
‘We conclude that routine AHR statistics can be used by IPCteams to extrapolate workable proxy indicators of HHcompliance.These can, in turn, be compared with HH rates fromdirect observation in order to identify overly optimistic orwidely discordant results. The method is by no meansperfect …’
Sell It! - Reminders
❖ How are you promoting an intervention to ensure that there are cues to action at the point of care and messages are reinforced to health workers and patients?
❖ Do you have capacity/funding to develop promotional messages and materials?
Sell it
You are selling a message
❖ Focus on an audience. Who do you want to target?
❖ Planning: IPC team strategy meetings every 2 months a
❖ Focus on a message
❖ What message is important for you to pass at this moment in your hospital?
❖ Make it appealing
Local Branding
Focus your message
Reminders on Wards
Billboards on Hospital Grounds
Be creative! Attract AttentionMASCOT
T-SHIRTS
FOB WATCH TO
EVERY HCW
CELEBRITY
ENDORSEMENT
PLAY IN
HOSPITAL
AUDITORIUM
Hand hygiene ‘road shows’❖ Annual event
❖ Keep it visible
❖ At different strategic locations: staff canteen, car park entrance, ward foyers
❖ Reach a large number of healthcare workers at once
Healthcare Staff Involvement
Social Media
What works with Doctors?!
❖ Evidence that hand hygiene works!
❖ Link to reduction in infection
❖ Show them local/own data
❖ Small group meetings/training
❖ Influence from peers and role models (IPC link doctors)
❖ Get them to know you and your team. Ask for feedback
Live It! Culture change
❖ Is there demonstrable support for the intervention at every level of the health system?
❖ For example, do senior managers provide funding for equipment/ resources?
❖ Are they willing to be champions and role models for IPC improvement?
❖ Are teams involved in co-developing or adapting the intervention? Are they empowered and do they feel ownership and the need for accountability?
Challenge!
❖ Poor Institutional safety climate
❖ Patient safety, risk management still very invisible
❖ No real drivers (e.g. insurance systems, accreditation requirements, medico-legal liability)
❖ Maltese Culture
❖ Risk tolerant
❖ Inequitable accountability
❖ Seen particularly with senior doctors
Hand Hygiene European Excellence Award
❖ To recognize, honor, and celebrate those hospitals and
healthcare worker groups who have used their
enthusiasm and knowledge to improve patient safety
through the successful implementation of the WHO
multimodal strategy in their healthcare facility
❖ www.hhea.info
2015 Winners!
54
What have we learnt? …
• Work in baby steps … focus• Measure• Feedback in a way they understand
• Build relationships! Listen!.
• Be creative• Acknowledge effort, improvement and successes• Perseverance!!!
Link it to WHY it is important
Multumesc!
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