SOAP- UP : Improving Hand Hygiene as a Comprehensive Infection Prevention Strategy

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1 SOAP- UP : Improving Hand Hygiene as a Comprehensive Infection Prevention Strategy Linda R. Greene, RN,MPS,CIC, FAPIC Manager of Infection Prevention University of Rochester, Highland Hospital Rochester, NY University of Rochester Medical Center linda_greene@urmc.rochester.edu Objectives Discuss current barriers in achieving an effective and sustainable hand hygiene program Explain how hand hygiene can be part of a comprehensive infection prevention strategy Identify practices for monitoring and improving compliance to hand hygiene Review literature to support hand hygiene Let the evidence speak Hospital Improvement Innovation Network 1

2 Why is this initiative different? Refreshes the thinking- new twist Connects the dots to harm Decreases complexity Cross Cutting Engages the front line Hospital Improvement Innovation Network 2

3 SOAP UP Must Do s Prompt Peer Performance Track Quietly and Trend Loudly Drive Drift Down Top 10 Checklist Hospital Improvement Innovation Network 3

4 Where it all began Background Hospital Improvement Innovation Network 4

5 The How and the When Key Points Hospital Improvement Innovation Network 5

6 4 Components of Good Hand Hygiene Hospital Improvement Innovation Network 6

7 Literature Findings Hospital Improvement Innovation Network 7

8 Hospital Improvement Innovation Network 8

9 Face to Face interviews with 13 senior managers at a large university hospital Seven distinct themes: Culture change starts with leaders Refresh and Renew the message Connect the 5 moments to the whole patient journey Actionable audit results Empower patients Reconceptualize non compliance Start the hammer Hospital Improvement Innovation Network 9

10 Participants All affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). Methods The control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-ofthe-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months Results 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI ) in favour of the team and leaders-directed strategy. Conclusions Our results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues Hospital Improvement Innovation Network 10

11 Hospital Improvement Innovation Network 11

12 Other Strategies UC insertion and maintenance Central line insertion and Maintenance Prevention of diarrheal outbreaks Hand Hygiene Prevention of c difficile Prevention of MDRO Surgical scurb Hospital Improvement Innovation Network 12

13 Connecting the Dots C difficile Monitoring Hospital Improvement Innovation Network 13

14 Preventing CAUTI Milisa Manojlovich, PhD, RN, CCRN Associate Professor University of Michigan School of Nursing. Study purpose: Determine if changes (in the hospital and nationwide) have contributed to improved catheter insertion practices Explore barriers and facilitators to adherence of urinary catheter insertion guidelines Manojlovich et al. Infect Control Hosp Epidemiol Methods 2 teams of nursing students , in 4 or 8 hour blocks of time January 29 June 30, 2014 Observation, checklists, field notes Hospital Improvement Innovation Network 14

15 Results No hand hygiene prior to 74% of insertions No hand hygiene in 91% post insertion 59% of insertion attempts were associated with a major break in sterile technique UC insertion and maintenance Central line insertion and Maintenance Prevention of diarrheal outbreaks Hand Hygiene Prevention of c difficile Prevention of MDRO Surgical scurb 30 Hospital Improvement Innovation Network 15

16 Engaging Patients Hand Hygiene those we care about deserve no less! Hospital Improvement Innovation Network 16

17 an engaged It takes a village I have all these powers, but no one listens to me! 33 Conclusions Hand Hygiene must be part of an overall strategy We must connect the dots to other HAI events Front line staff must be engaged Healthcare worker must trust our data When possible immediate feedback is important Hospital Improvement Innovation Network 17