6/8/2015 Kansas Quality Improvement Learning and Action Network Hand Hygiene: A Universal Infection Prevention Strategy Kansas Quality Improvement Learning Agenda • Basic principles of hand hygiene • Surveyor expectations • Hand hygiene monitoring • Educational resources • Additional resources 1
6/8/2015 WHO 5 moments for Hand Hygiene http://who.int/gpsc/tools/5moments HandHygiene_A3.pdf?ua=1 2
6/8/2015 Often Overlooked HH Partner… ...the patient/resident and visitor • How do you encourage hand hygiene with patients/residents and visitors? • Are hygiene products readily available to patients/residents and visitors for use? • Setting based challenges – Consider mobility of patient/resident – Do they go to a dining room? – Is hand hygiene completed prior to and post meals? Hospital Survey 42 CFR 482.42(a) • Section 2A: applies to all locations providing patient care – 2.A.1 – 2.A.6 – Note: Observations for compliance with hand hygiene elements should be assessed throughout the hospital. – Hand hygiene is performed in a manner consistent with hospital infection control practices, policies, and procedures to maximize the prevention of infection and communicable disease including the following… 3
6/8/2015 Hospital Survey 42 CFR 482.42(a) • 2.A.1 Soap, water, and a sink are readily accessible in appropriate locations including, but not limited to, patient care areas and food and medication preparation areas. • 2.A.2 Alcohol-based hand rub is readily accessible and placed in appropriate locations. – The locations may include: • Entrances to patient rooms, • At the bedside, • In individual pocket - sized containers carried by healthcare personnel, • Staff workstations, and/or • Other convenient locations Hospital Survey 42 CFR 482.42(a) • 2.A.3 Personnel perform hand hygiene: – Before contact with the patient – Before performing an aseptic task (e.g., insertion of IV or urinary catheter) • 2.A.4 Personnel perform hand hygiene: – After contact with the patient – After contact with blood, body fluids, or visibly contaminated surfaces – After removing gloves 4
6/8/2015 Hospital Survey 42 CFR 482.42(a) • 2.A.5 Personnel perform hand hygiene using soap and water when hands are visibly soiled (e.g., blood, body fluids) or after caring for a patient with known or suspected C. difficile or norovirus during an outbreak. • 2.A.6 Personnel do not wear artificial fingernails and/or extenders when having direct contact with patients at high risk of infection(e.g., those in intensive care units or ORs) per hospital policy. • If no to any of 2.A.1 through 2.A.6, cite at 42 CFR 482.42(a) (Tag A-0749) March 2015 LTC Survey Review • SW: SS=F: – Failed to clean an isolation precaution room appropriately & use standards of practice when providing peri-care • Observe staff clean isolation room & staff left room 4 times & did not remove PPE, change clothing or wash hands prior to leaving room or upon returning to room; staff failed to observe recommended wet contact times; staff unable to explain how prepared bleach water or how long bleach solution should set prior to wiping down surfaces; failed to clean isolation precaution room wearing appropriate personal protective equipment, failed to allow adequate wait time prior to wiping down chemical solution & failed to wash hands before & after cleaning room • Failed to ensure staff followed standards of practice & changed from dirty gloves after providing peri-care to clean gloves when applying a clean brief 5
6/8/2015 F441 • Tag F441 covers the infection control (IC) requirements in the 1987 Omnibus Budget Reconciliation Act (OBRA '87) regulations. They require an IC program, but do not specify either a committee or an infection control practitioner (ICP). These regulations address only six issues: case investigation, records, isolation, sick employees, hand washing, and linen handling. March 2015 LTC Survey Review • NW: SS=D: – Failed to provide infection control practices to prevent spread of infection • Observed inappropriate peri-care; staff failed to remove soiled gloves after removing soiled brief & soiled clothing before assisting res with clean clothing; failed to change gloves after performing peri-care, touched a soiled bag containing urine w/o gloves & failed to perform hand hygiene after performing care • NW: SS=F: – Failed to provide appropriate infection control practices during incontinent cares and failed to implement appropriate hand hygiene measures to prevent transmission of infections • Observed incontinent care & staff did not remove soiled gloves before leaving room to dispose of soiled brief; failed to provide appropriate IC practices during incontinent cares for res including proper hand hygiene as accepted by standards of practice to prevent potential transmission of infections 6
6/8/2015 March 2015 LTC Survey Review • NW: SS=E: – Failed to properly transport linen to minimize contamination & to provide a safe, sanitary & comfortable environment to help prevent development & transmission of disease & infection for residents by transporting res’ clean laundry, uncovered down hallway & not adequately cleaning res rooms • Observed staff clean res room & failed to change gloves between soiled & clean areas & failed to wash hands after cleaning room & staff unaware of how to clean a room infected with c-diff Hand Hygiene Program… • Competency assessment – Demonstration, use tools, etc. – Glo Germ, paint(for hand gel) • Compliance monitoring – Secret shopper – who does it? • Unit managers, volunteers, students – Volume monitoring – how much product are you going through? – Electronic surveillance systems • Soap dispensers, ipad/etc. – ATP monitoring 7
6/8/2015 Hand Hygiene Program… • Administrative issues – Policy/Process for repeat non-compliance – Component of job description – Included in performance evaluation • Timing and frequency – Product selection • Environmental assessment – Do you make it easy for staff to be compliant? – Are hygiene stations convenient – Consider in construction renovation Educational Resources 8
6/8/2015 http:// www.gojo.com/united-states/market/healthcare/long-term-care/resources/long-term-care- education.aspx NH Observation 9
6/8/2015 Whitepaper: Hand Hygiene in Skilled Nursing Facilities http://www.gojo.com/~/media/GOJO/Countries/USA/Ma rkets/Healthcare/LTC/Files/Resources/11741_SNF_White paper.pdf WHO Hand Hygiene Resources 10
6/8/2015 WHO Hand Hygiene Resources 11
6/8/2015 Automated Hand Hygiene Monitoring Systems Additional Resources • The Economics of Hand Hygiene Compliance Monitoring Hospital executives, infection prevention specialists and healthcare epidemiologists are by now familiar with a number of givens relating to healthcare-associated infections (HAIs): HAIs are happening, HAIs cost money, and HAIs can be controlled and prevented. This report examines the costs associated with HAIs and explores the benefits of healthcare worker hand hygiene compliance monitoring. http://www.infectioncontroltoday.com/~/media/Files/Medical/Ebooks/20 14/10/ICT_Hand%20Hygiene%20Comply%20Rpt_10_14_secure.ashx 12
6/8/2015 Additional Resources • How a team of doctors at one hospital boosted hand washing, cut infections and created a culture of safety Dr. Gerald Hickson launched the innovative program at Vanderbilt University Hospital after seeing wife’s post - operation care By Claudia Kalb July 21, 2014 4:27 AM Yahoo News http://news.yahoo.com/clean-hands--vanderbilt-s-hand-washing-initiative- 172312795.html Open Discussion & Sharing • How can we work together? – Opportunities to share expertise – Issues 13
6/8/2015 I want to wash my hands (1).mp4 Thank you! Brenda Groves, LPN Nadyne Hagmeier, RN QI Project Manager QI Project Manager 1-800-432-0770, ext 350 1-800-432-0770, ext 374 brenda.groves@area-A.hcqis.org nadyne.hagmeier@area-A.hcqis.org Joseph Scaletta, MPH, BSN, RN, CIC Director, KDHE Healthcare-Associated Infection Program 785-296-4090 jscaletta@kdheks.gov This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-GPQIN-KS-C1-83/0615 14
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