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Evaluation of Educational Methods for increasing Compliance with Isolation
E158
Vol. 36 No. 5
characteristics. The assessment also included a scale in which the nurses rated their level of suspicion for C. Difficile. After completing the assessment, a lab. test to detect C. Difficile toxin was ordered. Using the lab. test as the gold standard, sensitivity analysis was to determine the accuracy of nursing suspicion of C. Difficile. Results: Lab. test detected positive C. Difficile toxin among half (15) of the 30 patients. The accuracy of nurse’s level of suspicion for C. Difficile was 69%, sensitivity was 73%, specifity was 64%, positive predictive value was 69% and negative predictive value was 69%. In addition results indicated a significant association between high nursing suspicion for positive C. Difficile and actual predictive lab. test results for C. Difficile (p 5 0.042). Conclusion: Nurses have moderate to high degree of accuracy in predicting positive C. Difficile based on their observation of patientsÕ clinical symptoms. It is therefore recommended that nurses be permitted to independently order C. Difficile lab. test for ICU patients with diarrhea in whom they have high suspicion of C. Difficile.
Publication Number 17-159
Evaluation of Educational Methods for increasing Compliance with Isolation Elizabeth Curnow, MPH, CIC, Director, Infection Control, Rhonda Soto, RN, Infection Control Practitioner, Baptist Medical Center, San Antonio, TX. Background: Hand hygiene and isolation compliance have been identified as key to reducing the incidence of infections in hospitals today. Objective: The purpose of this focused study was to determine the impact of individual healthcare worker education versus group education for compliance to isolation precautions. The study compared two large medical/surgical patient care units and their staff by educating one group of healthcare workers in a group setting and the other by one-on-one education, in a large, urban, acute care setting. Methods: The population studied included the nursing staff from two Medical/Surgical units with mixed patient populations each with approximately 40 beds. The patient population on each unit was similar. The infection control department currently uses survey tools in conjunction with other departments (Quality Management and Safety) to help measure infection control and isolation compliance information. The instrument used typically measures information in addition to infection control and is completed on each unit on scheduled intervals. For the purposes of this study, the infection control portions of those surveys were combined and selected questions were completed, calculated and monitored locally by the Infection Control Department. Prior to compliance measurement, each sample group was given a short educational program focused primarily on the need for and the proper procedure for adherence to isolation precautions, including distribution of an optional Isolation checklist. Data collection involved staff interview, patient chart review and isolation cart evaluation and observation. Questions were marked as compliant or non-compliant and an overall score was calculated and compared statistically. Results: Sample group one (group education) was given education in a classroom format. Approximately 87% of the daytime staff were present for at least one of these group sessions. Sample group two (individual education), was given education with a one-on-one session between the Infection Control Practitioner and the healthcare worker. Approximately 87.5% of the daytime staff were trained in this manner. The mean score for the group education sample was 75.90% (N 5 15). The mean score for the one-on one education sample was 72.99% (N 5 13). These two means were compared statistically using the tTest and were found to have no significant difference with a p value greater than 0.05. Although the means did appear to show slight improvement over the course of the study in both groups, this was not tested statistically.
June 2008
E159
Conclusion: Currently, all staff receives basic infection control training at new hire orientation, as well as annual refresher training through an electronic, self-paced computer module. The research did suggest that there were opportunities for improvement on compliance with isolation with the highest mean score reaching only 75.90% in either sample group. Resulting recommendation from this study was for more research. Research should include finding new methods to reach this unique population of highly skilled and well-educated adults as well as methods to remove the barriers that health care workers face for demands to their time at work to allow learning. Healthcare, education and research must strive to identify the best way to help health care workers retain important information that could affect not only their patients health, but their own and that of their families.
Publication Number 17-160
Effective Recognition of Clean Equipment Marlene Fishman, MPH, CIC, Director, Glenn G. Fort, MD, MPH, Infectious Disease Specialist, Dennis J. Mikolich, MD, Infectious Disease Specialist, St. Joseph Health Srvs RI, North Providence, RI. Issue: Staff ability to identify clean equipment has been inconsistent. An interdisciplinary focus team was established to develop a new system. Hot pink key ring coil identification tags were trialed successfully on a rehabilitation unit and sub-acute nursing floor. Nursing, housekeeping, physical and occupational therapists were trained. The system was then introduced facility-wide. Project: Pilot program began August 2005 with written draft policy, %91Think PinkÕ slogan and quick reference pink instructions that declared the following: 1) Clean equipment between each patient use, 2) Return cleaned equipment to designated storage area, 3) Cleaned equipment that is not stored in a designated area should be labeled with a pink ÔReady For UseÕ identification tag, 4) Assume equipment is dirty if it is not labeled and it is not stored in a designated storage area. Monitoring form was created with written instructions, tested for reliability, and used to determine staff understanding of the new identification system and compliance with the use of the identification tags. Decision was made by the Patient Safety Committee to implement facility-wide. Pop-up disinfectant wipes were purchased to facilitate proper and timely disinfection. Informational storyboards were presented to all departments. Training began at the Annual Education Expo, utilizing interactive demonstrations. Follow-up monitoring program was developed with revised monitoring tools tailored to equipment used in general, dental and rehab programs. Additional form has been developed to monitor not only the use of the identification tag, but also to show efficacy of the disinfection. Reliabilty testing is in progress. Promotional items included a hot pink bookmark which highlighted the three basic steps in a clean equipment bundle. Hot pink promotional items were included in the Education Expo as a means of engaging staff. Results: Queried staff on the trial floors recognized unlabeled equipment as ÔdirtyÕ. Equipment on nursing floors and gym were properly tagged after disinfection. Items disinfected and then stored in the designated clean equipment storage areas did not require identification tags. Staff were enthusiastic not only about having pop-up disinfectant wipes, but also the ability to easily identify cleaned equipment. Facility-wide training sessions clearly indicated the need to educate staff regarding how well or how poorly they were cleaning equipment. Participants at the Education Expo failed 72% of the time in their attempts to remove simulated ÔgermsÕ that glowed under black light when planted on a computer keyboard, telephone, thermometer or Doppler. Hot pink promotional items included hot pink note pads, pink badge holders and pens from the International Infection Prevention Week campaign and an assortment of pink gadgets and cleaning supplies. Lessons Learned: This unique approach to identifying cleaned equipment by using a key ring coil with an easily recognizable hot pink identification tag is very simple and very effective. There is no need to date the identification tag. Nor does one have to deal with residue from tape or labels. Follow-up observations are planned.
Vol. 36 No. 5
characteristics. The assessment also included a scale in which the nurses rated their level of suspicion for C. Difficile. After completing the assessment, a lab. test to detect C. Difficile toxin was ordered. Using the lab. test as the gold standard, sensitivity analysis was to determine the accuracy of nursing suspicion of C. Difficile. Results: Lab. test detected positive C. Difficile toxin among half (15) of the 30 patients. The accuracy of nurse’s level of suspicion for C. Difficile was 69%, sensitivity was 73%, specifity was 64%, positive predictive value was 69% and negative predictive value was 69%. In addition results indicated a significant association between high nursing suspicion for positive C. Difficile and actual predictive lab. test results for C. Difficile (p 5 0.042). Conclusion: Nurses have moderate to high degree of accuracy in predicting positive C. Difficile based on their observation of patientsÕ clinical symptoms. It is therefore recommended that nurses be permitted to independently order C. Difficile lab. test for ICU patients with diarrhea in whom they have high suspicion of C. Difficile.
Publication Number 17-159
Evaluation of Educational Methods for increasing Compliance with Isolation Elizabeth Curnow, MPH, CIC, Director, Infection Control, Rhonda Soto, RN, Infection Control Practitioner, Baptist Medical Center, San Antonio, TX. Background: Hand hygiene and isolation compliance have been identified as key to reducing the incidence of infections in hospitals today. Objective: The purpose of this focused study was to determine the impact of individual healthcare worker education versus group education for compliance to isolation precautions. The study compared two large medical/surgical patient care units and their staff by educating one group of healthcare workers in a group setting and the other by one-on-one education, in a large, urban, acute care setting. Methods: The population studied included the nursing staff from two Medical/Surgical units with mixed patient populations each with approximately 40 beds. The patient population on each unit was similar. The infection control department currently uses survey tools in conjunction with other departments (Quality Management and Safety) to help measure infection control and isolation compliance information. The instrument used typically measures information in addition to infection control and is completed on each unit on scheduled intervals. For the purposes of this study, the infection control portions of those surveys were combined and selected questions were completed, calculated and monitored locally by the Infection Control Department. Prior to compliance measurement, each sample group was given a short educational program focused primarily on the need for and the proper procedure for adherence to isolation precautions, including distribution of an optional Isolation checklist. Data collection involved staff interview, patient chart review and isolation cart evaluation and observation. Questions were marked as compliant or non-compliant and an overall score was calculated and compared statistically. Results: Sample group one (group education) was given education in a classroom format. Approximately 87% of the daytime staff were present for at least one of these group sessions. Sample group two (individual education), was given education with a one-on-one session between the Infection Control Practitioner and the healthcare worker. Approximately 87.5% of the daytime staff were trained in this manner. The mean score for the group education sample was 75.90% (N 5 15). The mean score for the one-on one education sample was 72.99% (N 5 13). These two means were compared statistically using the tTest and were found to have no significant difference with a p value greater than 0.05. Although the means did appear to show slight improvement over the course of the study in both groups, this was not tested statistically.
June 2008
E159
Conclusion: Currently, all staff receives basic infection control training at new hire orientation, as well as annual refresher training through an electronic, self-paced computer module. The research did suggest that there were opportunities for improvement on compliance with isolation with the highest mean score reaching only 75.90% in either sample group. Resulting recommendation from this study was for more research. Research should include finding new methods to reach this unique population of highly skilled and well-educated adults as well as methods to remove the barriers that health care workers face for demands to their time at work to allow learning. Healthcare, education and research must strive to identify the best way to help health care workers retain important information that could affect not only their patients health, but their own and that of their families.
Publication Number 17-160
Effective Recognition of Clean Equipment Marlene Fishman, MPH, CIC, Director, Glenn G. Fort, MD, MPH, Infectious Disease Specialist, Dennis J. Mikolich, MD, Infectious Disease Specialist, St. Joseph Health Srvs RI, North Providence, RI. Issue: Staff ability to identify clean equipment has been inconsistent. An interdisciplinary focus team was established to develop a new system. Hot pink key ring coil identification tags were trialed successfully on a rehabilitation unit and sub-acute nursing floor. Nursing, housekeeping, physical and occupational therapists were trained. The system was then introduced facility-wide. Project: Pilot program began August 2005 with written draft policy, %91Think PinkÕ slogan and quick reference pink instructions that declared the following: 1) Clean equipment between each patient use, 2) Return cleaned equipment to designated storage area, 3) Cleaned equipment that is not stored in a designated area should be labeled with a pink ÔReady For UseÕ identification tag, 4) Assume equipment is dirty if it is not labeled and it is not stored in a designated storage area. Monitoring form was created with written instructions, tested for reliability, and used to determine staff understanding of the new identification system and compliance with the use of the identification tags. Decision was made by the Patient Safety Committee to implement facility-wide. Pop-up disinfectant wipes were purchased to facilitate proper and timely disinfection. Informational storyboards were presented to all departments. Training began at the Annual Education Expo, utilizing interactive demonstrations. Follow-up monitoring program was developed with revised monitoring tools tailored to equipment used in general, dental and rehab programs. Additional form has been developed to monitor not only the use of the identification tag, but also to show efficacy of the disinfection. Reliabilty testing is in progress. Promotional items included a hot pink bookmark which highlighted the three basic steps in a clean equipment bundle. Hot pink promotional items were included in the Education Expo as a means of engaging staff. Results: Queried staff on the trial floors recognized unlabeled equipment as ÔdirtyÕ. Equipment on nursing floors and gym were properly tagged after disinfection. Items disinfected and then stored in the designated clean equipment storage areas did not require identification tags. Staff were enthusiastic not only about having pop-up disinfectant wipes, but also the ability to easily identify cleaned equipment. Facility-wide training sessions clearly indicated the need to educate staff regarding how well or how poorly they were cleaning equipment. Participants at the Education Expo failed 72% of the time in their attempts to remove simulated ÔgermsÕ that glowed under black light when planted on a computer keyboard, telephone, thermometer or Doppler. Hot pink promotional items included hot pink note pads, pink badge holders and pens from the International Infection Prevention Week campaign and an assortment of pink gadgets and cleaning supplies. Lessons Learned: This unique approach to identifying cleaned equipment by using a key ring coil with an easily recognizable hot pink identification tag is very simple and very effective. There is no need to date the identification tag. Nor does one have to deal with residue from tape or labels. Follow-up observations are planned.