Canadian Hand Hygiene Audit Event

Mar 26, 2014

Welcome from the teamBienvenue, de la part de l’équipe

Gina PeckAnne MacLaurin Virginia Flintoft Alexandru Titeu

Hélène Riverin Dr. Michael Gardam Leah Gitterman

Where are you joining from? Use your pointer Où êtes-vous joindrez à partir? Utilisez votre pointeur

Discuss the details of the Canadian Hand Hygiene Audit EventReview process of conducting Hand Hygiene observationsData collection tips for the Canadian Hand Hygiene Audit Event

Purpose of today’s call

Canadian Hand Hygiene Audit

When?– April 2014

Purpose:– Create awareness around appropriate Hand

Hygiene practice– Obtain an estimate of national Hand Hygiene

rates– Promote the new Data Collection Tool and to

support good Hand Hygiene

Canadian Hand Hygiene Audit

Your commitment:– 50 moments per unit– Secure executive sponsor support and

resources as required.

Who is included?

The Canadian Hand Hygiene audit will focus on:– Acute Care– Long-term Care– Home Care

Audit sample can be:– Entire organization– Specific units or programs

Hand Hygiene Observation and Analysis

Michael GardamLeah Gitterman

HAND HYGIENE OBSERVATION AND ANALYSIS

Leah GittermanUniversity Health Network

Infection Prevention and Control

Direct observationUse the 4 momentsConduct observations openly without interfering with ongoing workAnonymous observationFeedback the data to the front line staff

How to observe hand hygiene

Moment: refers to the 4 times it is essential that HCW’s clean their hands

Opportunity: need to perform hand hygiene

Terminology

Zimmerman et. al. Healthcare Papers 2013

How will you identify types of healthcare workers? Introduce yourself to the unitLearn the workflow of the area you are auditingBe open to answering questions from staff and patients

Preparing to Audit

Suggested to observe up to 3 HCW’s at a timeEach observation session takes on average 20 minutes (can be some variability here)Try to audit at different times/shifts

Preparing to audit

How to use the form

• Each column is for recording hand hygiene opportunities of one health care provider only. Use additional columns for each additional health care provider being observed

Note: The Long-Term Care Observation Tool uses “Category” instead of HCP.

• As soon as you observe the first indication for hand hygiene, indicate the corresponding information in the first of the numbered opportunity sections in the column corresponding to the health care provider being observed.

Before initial patient/environment contact (BEF-PAT/ENV)

• if the health care provider touches the patient’s environment and then touches the patient or

• goes directly to touch the patient after having touched the hospital environment (= any other surface not in the patient’s environment) or another patient’s environment

• if the health care provider enters the patient’s environment and touches only the patient’s environment (does not touch patient) and then leaves the patient’s environment.

Before Aseptic Procedure (BEF-ASP)

• Wound care, dressing change, wound assessment

• Manipulate an invasive device (e.g., priming intravenous infusion set, inserting spike into opening of IV bag, flushing line, adjusting intravenous site, administering medication through IV port, changing IV tubing).

After body fluid exposure (AFT-BFL)

After contact with blood or blood products, emptying urinal/catheter bag and suctioning oral/nasal secretions

After patient/patient environment (AFT-PAT/ENV)

• health care provider leaves the patient and his/her environment to go on working in the hospital environment or with another patient

• health care provider leaves the patient area after touching objects in the patient environment (without touching the patient) to go on working in the hospital environment or with another patient.

Ensure that staff know what you are auditingBe open and honest about the processBe clear from the beginning if you will be using ‘on the spot’ feedbackShare the data regularlyBe consistent!

Tips

E.g. HCW enters a room, cleans hands with alcohol and then immediately performs an aseptic procedure. This counts as BEF-PAT/ENV and BEF-ASP

Document whether alcohol or soap and water was used.

Mark down all opportunities and type of HH action performed

Indicate if gloves were worn and if HH performed appropriately before and after

Refer to your facility's policy on rings, bracelets and nails

If auditing is new, consider not focusing on the timing of duration of HH. Add this in once the overall process for auditing is running smoothly

Gloves, nails, bracelets, rings, timing

The nurse opens the door, uses alcohol hand gel enters the room and goes towards the patient and introduces herself

The nurse moves the bedside table

The nurse helps the patient to bring out his arm from under the sheets

Scenario 1

Key messages:• The nurse performs hand hygiene while

approaching the patient environment. • The nurse handrubs before touching surfaces

and objects. As these are part of patient’s environment, it is not necessary to perform hand hygiene again before touching the patient.

• The indication remains “before initial patient/patient environment contact.”

Scenario 1

• The nurse uses alcohol based hand rub in the corridor

• The nurse is on his way to the room and suddenly remembers he needs to make a phone call. The nurse uses the phone in the waiting area (last contact with health care environment) and then goes directly into the room towards the patient

• The nurse helps the patient to bring his arm out from under the sheets

Scenario 2

Key messages: After performing hand hygiene in the corridor (additional action not corresponding to any recommended indication), the nurse then touches the phone in the waiting area and thus potentially contaminates his hand.

The nurse then misses the action before initial patient/patient environment contact, potentially contaminating him with those germs

Scenario 2

• The nurse enters the room, performs HH and places the equipment ready for giving an IV medication on the overbed table

• IMED pump alarms so nurse resets pump

• The nurse moves the overbed table and performs HH

• The nurse cleans the IV port and injects the medication into the IV port (aseptic procedure)

Scenario 3

• Key Messages: The nurse has a first direct contact with the patient (performs hand hygiene as indicated) and the patient environment; she then repeats the hand hygiene action before the aseptic procedure to protect the patient from her own organisms.

Scenario 3

• The gloved nurse in the room punctures the patient’s finger and squeezes drops of blood onto a strip and then tests with the glucometer

• When the nurse finishes, she places the lancet in the sharps container and then places the alcohol swab in the garbage. She then takes off her gloves and places them into the garbage

• The nurse takes the patient's pulse

Scenario 4

• Key messages: Hand hygiene must be performed immediately after body fluid exposure risk, before touching either the patient again or any surface and object within the patient environment or health care environment, to prevent potential dissemination of organisms. Any care activity implying contact with body fluids constitutes a risk because exposure may not be visible but may have happened.

Scenario 4

How to participate?

Alexandru TiteuCentral Measurement Team

Patient Safety Metrics - IntroductionGetting Data In– Data Collection Forms (DCF) – Patient-level– Worksheets - Numerator and Denominator– Hand Hygiene Audit – Acute, LTC, Home Care– Requirements for Faxing

Patient Safety Metrics - Demo– How to enroll in Hand Hygiene Intervention for all sectors– How to add and generate the forms– How to view data and run reports

Agenda

Features:Cloud-based data collection and reporting tool – no cost to userAccessible by registered members (email and password)Available in English and FrenchTracks >100 process and outcome measures over 14 interventionsProvides real time reporting and export of data to CSV/Excel Roll Up or Drill Down Reports (i.e. Unit Organization Health Region Province National) with automated Run Charts

Patient Safety Metrics

Getting Data In

Data Collection (Audit) Forms

Data Collection (Audit) Forms - DCF– Patient-level data (de-identified) - daily– Multiple data elements – Print form Collect data Fax form – Automatic roll-up to Measurement

Worksheets

Data Collection Forms

Hand Hygiene Audit Tool

so we may contact you in the event of an error

Hand Hygiene Audit Tool

Long-Term Care and Home Care

Acute Care

+ Family caregiver

Hand Hygiene Audit Tool

Acute Care

Hand Hygiene Audit Tool

Once per  HCP

Patient-Family HH Data Collection Form

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Are you collecting HH observations

from the Pt-FamilyPerspective?

Are you collecting HH observations in Home Care?

Tell us how in the ‘chat’ box…

Enter your Name, Phone Number, and E-mail in the top-left corner (so we may contact you in the event of an error)Enter all elements of the Date (year, month, day) on all formsEnter Day as a double digit (e.g. the 3rd should be entered as 03, with 0 on the top row and 3 on the row below)

Requirements for faxing DCFs

Fax in batches that are 10 pages or lessFax with NO COVER PAGESet fax machine to FINE or SUPERFINE RESOLUTIONUse a Flatbed (flat glass scanning) fax machine if possibleLogin to PSMetrics one hour after faxing your forms to verify the data was received successfully

Requirements for faxing DCFs

Do not hole punch, fold or spill anything on the formDo not cross out bubbles if you made a mistake, use the VOID bubble to exclude wrong sectionsFill in bubble completely (Sharpie is best, pen and pencil are OK) - do not stack forms because ink may bleed through the paperDo not write or make extra markings on the form

Beware of common mistakes!

Getting Data In

Measurement Worksheet

Measurement Worksheets– Aggregate data - monthly – Numerator and Denominator– Created automatically when you add your

DCFs

Measurement Worksheets

Accessing Measurement Worksheet

https://psmetrics.utoronto.ca/metrics/login.aspx

Accessing Measurement Worksheet

Accessing Measurement Worksheet

Entering Data on Msmnt Worksheet

Entering Data on Msmnt Worksheet

Patient Safety Metrics - Live Demo

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Patient Safety Metricshttps://psmetrics.utoronto.ca/metrics/login.aspx

Central Measurement TeamVirginia Flintoft & Alexandru Titeumetrics@saferhealthcarenow.ca

STOP! Clean Your Hands Day

Journée ARRÊT! Nettoyez-vous les mains

Register now! / Inscrivez-vous maintenant!

www.handhygeine.ca

www.hygienedesmains.ca

Upcoming calls / Appels à venir

STOP! Clean Your Hands Day: Brief summary of Hand Hygiene Audit Results followed by ‘What’s Your Hand In It’: Pitch to the ‘Dragons’May 5th, 2014https://cpsi-icsp.webex.com/cpsi-icsp/j.php?J=965929460Time:

9:00 -10:30 a.m. PDT /10:00 -11:30 a.m. MDT /11:00 a.m. – 12:30 p.m. CDT /12:00 -1:30 p.m. EDT /1:00 -2:30 p.m. ADT /1:30 -3:00 p.m. NDT

Presentation of Findings from the Canadian Hand Hygiene Audit EventMay 20th, 2014https://cpsi-icsp.webex.com/cpsi-icsp/j.php?J=963305754Time:

9:00 -10:00 a.m. PDT /10:00 -11:00 a.m. MDT /11:00 a.m. – 12:00 p.m. CDT /12:00 -1:00 p.m. EDT /1:00 -2:00 p.m. ADT /1:30 -2:30 p.m. NDT

Series of Hand Hygiene Improvement Calls : Date, Time and Topic TBD

Questions?

Thank You / Merci

Evaluation Poll

Sondage d’évaluation