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Volunteers and Patients as Hand Hygiene "Partners in Care"

Island Health, British Columbia

Patient engagement in hand hygiene (HH) is one of Island Health's strategies for improving the patient experience and decreasing healthcare associated infections that can result in excess length of stay, morbidity and mortality. It is well known that volunteers contribute greatly to personalizing, humanizing and demystifying the hospital experience, so it was only fitting that Island Health would engage volunteers educated in proper hand hygiene by its own infection control practitioners to supplement the existing independent auditors working to engage patients in their own education on hand hygiene.

During the volunteer's visit, the patient, their visitors and their family are taught how and why to do proper hand hygiene. The patient is then asked to participate in a perception survey and monitor their healthcare workers (HCW) HH practices before and after moments of care. The survey is not a tool to measure accuracy but to support existing HH results and includes the engagement of physicians and all staff on the unit.

The results of the six-month pilot indicated that the vast majority of patient commentary on the survey cards expressed satisfaction with survey participation and HCW hand hygiene practices.  Patients learned proper HH practices and were given the opportunity to observe and ask their HCWs to clean their hands before and after care. While the project was not specifically designed as an intervention for improving HH rates among healthcare providers, interestingly we found HH Rates at the pilot units have increased dramatically.

The goal of this initiative is to foster HH culture at Island Health by providing HH education to patients as well as engaging patients and healthcare providers in improving HH practice. The ultimate goal is to improve patient safety (Health Standards Organization 2014).

Toronto East General Antimicrobial Stewardship Program (ASP)

Toronto East General Hospital (TEGH) / Michael Garron Hospital, Ontario

An estimated 30-80 per cent of antimicrobials used in hospitals are unnecessary. Antimicrobial overuse promotes the development of superbugs like C. Difficile, Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), and Extended Spectrum B-lactamase producing bacteria (ESBL). Prior attempts to reduce antimicrobial use with antimicrobial guidelines or formulary restrictions (i.e., limiting which antimicrobials can be used) have demonstrated little success in reducing unnecessary antimicrobial use. A model of prospective audit and feedback was utilized as the basis for the TEGH Antimicrobial Stewardship Program (ASP) quality improvement intervention. The selection of this model was based on available evidence and the feedback elicited from the healthcare team.

During the process of prospective audit and feedback an individual patient's antimicrobials are reviewed by the ASP with feedback and education provided directly to care providers. Since the implementation of the TEGH ASP there has been a 30 per cent reduction in antimicrobial costs and significant reductions in the use of broad spectrum antimicrobial agents. Patient outcome data has demonstrated stability in mortality rates and average length of stay, with some wards demonstrating a reduction in seven-day readmission rates. Institutional rates of hospital acquired C. Difficile have also significantly decreased from an average monthly rate of 0.67/1000 patient-days to 0.42/1000 patient days since ASP implementation (Health Standards Organization 2012).