Alicia Cortright and Alison Devine, Infection Control Professionals with Alberta Health Services in Red Deer, Alberta light-heartedly call it their “dirty little secret.” During Stop! Clean Your Hands Day on May 5, 2011, Cortright and Devine provided insight into how their acute care units increased hand hygiene compliance. The secret? Let your staff focus on the infection control strategy they believe in, as all infection control initiatives lead back to hand hygiene.
In 2008, a group of concerned nurses working in the 35-bed general surgical unit at the Red Deer Regional Hospital Centre (RDRHC) got together with Alison to brainstorm ways to decrease the spread of methicillin-resistant Staphylococcus aureus (MRSA).
“We decided to take an open-minded approach and let the process unfold in a way that worked best for the front-line staff,” says Devine. “We quickly realized that it did not matter where we started, all initiatives led back to hand hygiene. The way in was where they wanted to take us, rather than where we thought would be the best place to start.”
Since then, seven of the units at RDRHC have been monitoring hand hygiene before and after patient care. Monthly compliance over time on these units has ranged from 63 to 94 per cent, with an average of 77 per cent of healthcare providers washing their hands before and after patient care. The monthly results are shared with the staff on the unit to reinforce optimal hand hygiene.
“When the staff on the unit see how they are doing and the results are less than optimum, they become more vigilant and are first to speak to their peers about washing their hands,” says Cortright. “Our goal is to have hand hygiene become an ongoing practice rather than just the project of the month and we are well on our way to accomplishing that. As an example of how hand hygiene has become integrated into the culture, one healthcare provider said, I saw that our compliance was down this month and made sure to wash my hands on rounds. A lot. In an obvious way.”
On the participating units, healthcare acquired MRSA rates were about 2.94 cases per month prior to this initiative and are now about .53 cases per month. The first unit has not had a single case of HA-MRSA in over a year and another has not had a single case of hospital-acquired Clostridium difficile infection (HA-CDI) for 10 months.
Both Cortright and Devine say that the success of this initiative is the fact that it is staff led and driven and support from managers and senior administration is essential. A multidisciplinary working group was formed and five strategies were implemented:
Focus on all groups to increase hand hygiene compliance.
Implement social marketing framework to influence action and behaviours.
Identify leaders and form a workgroup – the RDRHC workgroup included representatives from nursing, nursing management, environmental services, unit assistants and infection control.
Research your target audience. Identify barriers to hand hygiene by discussing issues in staff work groups. Some barriers tumbled easily, others the RDRHC continues to chip away at.
Look at your infrastructure and make it easy – including the location of sinks and alcohol based hand rub (ABHR).
Click here to listen to and access a copy of Cortright and Devine’s presentation during STOP! Clean Your Hands Day. You can also contact Alison Devine firstname.lastname@example.org to obtain a copy of the RDRHC framework, including 12 practical steps to get started on addressing hand hygiene compliance.