Improving Hand Hygiene in the Long-Term Care Setting

Eshley May PacamalanUniversity of Central Florida

Significance of Problem Healthcare associated infections (HAIs) pose a major threat to patient

safety and affect hundreds of millions of people worldwide (WHO, 2009) Seen in approximately 722,000 patients in acute care hospitals in 2011, with

approximately 75,000 patients dying during hospitalizations (CDC, 2014) Cost $6.5 billion in 2004 and increased to $33.8 billion in 2009 (Spruce, 2013)

The long-term care (LTC) setting further contributes to the susceptibility of infection

Resident socialization and use of common areas allow for increased person-to-person spread and exposure to contaminated surfaces (Schweon et al., 2013)

Hand hygiene has been proven to be the easiest, least expensive, and most significant practice to prevent the spread of pathogens (Mathur, 2011).

However, it continues to be a problem among healthcare workers due to lack of compliance (WHO, 2009)

Baseline Data Setting: 95-bed assisted living facility

(ALF) with 18 staff members

Data collection: Administer surveys to measure

employees’ existing knowledge regarding hand hygiene

Utilize direct observation – Complete in the period of two months prior to implementation

Record the number of clients hospitalized due to HAIs within six months prior to implementation

Tools: From the WHO’s Clean Care is Safer Care initiative

Questionnaires Observation forms

(WHO, 2014)

Potential Strategies Install touch-free hand sanitizer dispensers in high-traffic areas Place hand sanitizing wipes in common areas Provide an educational program for healthcare professionals Provide educational information about the program to residents Monitor compliance (Schweon et al., 2013)

Show positive role modeling Utilize performance indicators (Mathur, 2011)

Integrate compliance into the culture of the organization Reminders Appropriate rewarding Enhancing self-efficacy

Ensure a multimodal and multidisciplinary approach(CDC, 2002)

Culture & Change Management Strategies Stakeholders of the plan

Managerial staff Administrator – Must grant permission for the project

Stakeholder engagement benefits Early buy-in, successful design, & establishment of long-term support Can help contribute suggestions for formation and implement continuous quality

improvement

Obtaining stakeholder buy-in Present the PI Plan, emphasizing:

The current growing issue of hand hygiene practices The potential effects that may negatively influence the health of the clients and

the success of the business Positive outcomes, with the goal of improved safety throughout the entire

organization

Achieving continued engagement Regular communication & management of expectations (AHRQ, 2008)

Plan Design – Performance Improvement Method

TeamSTEPPS Model

Step 1: Assessing the need Form a change team Perform a needs analysis Identify issues Define goals

Step 2: Planning, training, & implementation

Outline a plan for intervention Develop an evaluation plan Prepare the organization Establish a communication plan Implement the interventions

Step 3: Sustainment Provide continuous feedback Measure success Update Plan

(AHRQ, n.d.)

Plan Design –Interventions

Education Implement a teaching program for all staff Offer educational opportunities for all residents

Both would focus on the basics of hand hygiene, with visual and written materials How & when we wash our hands Factors for noncompliance

Environmental adaptation Install hand sanitizer dispensers in high-traffic areas Place sanitizing wipes in common areas Display posters for reminders to residents and staff

Active Participation Front line staff Administrative staff – Shows support and positive role-modeling

Plan Design – Resources Timeline Educational materials

Tools for presenting Laptop Projector for slide and video Written documents for

questionnaires, handouts, and posters

Additional supplies to be added to the physical setting

Dispensers and wipes

Personnel who will be teaching and observing

4 staff (2 RNs and 2 CNAs) would serve as liaisons, facilitating proper practices and observing for improvement

Two month period of baseline data collected by the liaisons

Divided among three shifts to ensure complete record of all staff

Use of a standardized observation form

Two month period of training for all staff

With weekly meetings for questions and concerns

Two month period for outcome evaluation by the liaisons

Utilization of the same methods used with initial data collection

Yields six months of implementation Plus continuous adjustment and

application

Plan Design – Projected Goals Feasibility To increase staff knowledge and

implementation of proper hand hygiene

100% on the knowledge-based questionnaire

100% compliance

To decrease facility acquired infections By 50% in the first 6 months of

implementation Completely eradicated after a year

of implementation and every year thereafter

Very high Resources have already been

developed Personnel are already employed

within the organization All required components are within

the scope and capabilities of the staff

Its application is reasonable and its goals are achievable

Multimodal strategies have been highly advised by various studies, therefore, multiple aspects of improvement are preferred for this facility.

Possible Cost & Potential Savings Very cost efficient

All teachings and interventions done by existing staff No additional individuals needed for the collection of data

Additional costs Educational materials Supplies for physical environment

Total estimated cost: $300, plus the continued cost for refilling the dispensers/wipes

Laptop and projector (already owned) $0 Printed materials $100 Hand sanitizer dispensers $100 (5 units at $20 each) Sanitizing wipes and sanitizer refills $100 (initial cost)

Savings Determined by the number of clients who were prevented from experiencing an HAI Based on the current HAI rates and the financial losses associated with hospitalization

The benefits of the PI Plan far succeed its financial aims, as the improved health and wellbeing of the clients are the main focus of its implementation.

Outcome Evaluation Measure the knowledge and compliance of the staff, compared before and 6

months after implementation Questionnaire scores

Based on percentages of correct answers Observational accounts

Based on adherence rates: Number of times the hand hygiene practices were performed compared to the number of opportunities that had arisen

(TJC, 2009)

Measure the number of facility-acquired infections, compared by the time period 6 months before and 6 months after implementation

Sustainability Annual administration of questionnaires Quarterly observations for compliance Semi-annual evaluations of facility-acquired infections

ReferencesAgency for Healthcare Research and Quality. (n.d.). About TeamSTEPPS. Retrieved from

http:/ / teamstepps.ahrq.gov/ about-2cl_3.htm.

Agency for Healthcare Research and Quality. (2008). Engaging stakeholders in a care

management program. Retrieved from

http:/ / www.ahrq.gov/ professionals/ systems/ long-term-

care/ resources/ hcbs/ medicaidmgmt/ medicaidmgmt2.html.

Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care

settings. Retrieved from http:/ / www.cdc.gov/ mmwr/ PDF/ rr/ rr5116.pdf.

Centers for Disease Control and Prevention. (2014). Healthcare-associated Infections. Retrieved

from http:/ / www.cdc.gov/ HAI/ surveillance/ index.html.

Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. Indian Journal of

Medical Research, 134(5), 611-621.

Schweon, S., Edmonds, S., K irk, J ., Rowland, D., & Acosta, C. (2013). American Journal of

Infection Control, 41(1), 39-44.

Spruce, L. (2013). Back to basics: Hand hygiene and surgical hand antiseptics. AORN

Journal, 98(5), 449-460.

The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges.

Retrieved from http:/ / www.jointcommission.org/ assets/ 1/ 18/ hh_monograph.pdf.

World Health Organization. (2009). Guide to Implementation. Retrieved from

http:/ / whqlibdoc.who.int/ hq/ 2009/ WHO_IER_PSP_2009.02_eng.pdf?ua=1.

World Health Organization. (2014). Clean Care is Safer Care: Tools for training and education.

Retrieved from http:/ / www.who.int/ gpsc/ 5may/ tools/ training_education/ en/ .