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Surgical Site Infection Prevention Initiative: Patient Attitude and Compliance
www.ajicjournal.org Vol. 38 No. 5
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Results: The total number of SSIs decreased in 2009. Craniotomy infections in patients with a NHSN Risk index 0 or 1 have decreased 46% to date, from 1.93% to 1.04%. Laminectomy infections among patients with a risk index of 0 or 1 have decreased 23%, from 1.55% to 1.2%. There is improved compliance with proper surgical hand scrubbing, incision site washing and prepping, antibiotic prophylaxis timing, and sterile field maintenance. Lessons Learned: SSI prevention is critical to improving patient safety. Engaging all stakeholders, empowering a task force to develop guidelines, facilitating ownership of the process by all involved and creating a cooperative spirit during implementation has moved us closer to the goal of zero infections. Presentation Number 12-137
Squeaky Clean Hands Result from Child/Family Directed Care Barbara J. Simmonds, RN, BS, CIC, Director, Miami Children’s Hospital, Miami, FL Issue: Patient-directed care was the guiding philosophy in our commitment to achieve the critical patient safety goal of hand hygiene. IHI states that in spite of well-established hand hygiene standards, procedures are only followed by health care staff approximately 50% of the time, facilitating the transmission of health-care-associated pathogens to patients. This presentation will demonstrate one organization’s journey to bring the first line of defense to life with involvement of children and families to direct care. This multi-pronged approach could easily be replicated in other settings. Project: In 2008, under the direction of members of the Family Advisory and Teen Advisory Councils, the 282-bed, acute-care, free-standing children’s hospital began the SQUEAKY CLEAN adventure by reviewing the following: dHand hygiene best practices from other children’s hospitals dParent perception of compliance by interviews and direct observation dAnalysis of hand washing dispensers throughout the organization dTypes of product used. Common language was developed with education given to the child/family, on admission, reinforcing that hand washing protects the child’s safety. Housewide staff education was done with scripting of ‘‘I’m washing my hands for your safety; please be sure everyone does the same.’’ The child/family receives a ticket book and can then ‘‘reward’’ the care givers for appropriate hand hygiene by immediately offering a ‘‘ticket’’ in recognition of performing hand hygiene. Tickets are accumulated by staff and may be turned in for rewards. The child/family also redeems the empty ticket book for a prize on discharge. ‘‘Take-home’’ hand-hygiene education is given to the child/family. The children enjoy giving out tickets allowing them to control their unfamiliar environment. The staff members are engaged as the children distribute ‘‘rewards’’ or remind them to wash their hands. In 2009 SQUEAKY CLEAN was extended to the offcampus sites. Results: Compliance rates over the last 4 quarters show our goal of 4.5 was met. Lessons Learned: Children/Families eagerly engage in their own care, becoming partners toward a common goal with the healthcare workers. This program gives the patient ‘‘permission’’ to speak up and be assured of SQUEAKY CLEAN HANDS! Presentation Number 12-138
Surgical Site Infection Prevention Initiative: Patient Attitude and Compliance Faith Skeete, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY; Nancy Berger, RN; Kandy Kraemer, RN, Perioperative Services; Louise Comeau, DNP, Acute Surgical Services, New York University Hospital for Joint Disease, New York, NY; Michael Phillips, MD, Hospital Epidemiologist, New York University Langone Medical Center, New York, NY; Janet Haas, DNSc, Director, Infection Prevention and Control, Westchester Medical Center, Valhalla, NY; Steven Bock, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY; Joseph Bosco, MD, Department of Orhtopedics; Andrew Rosenberg, MD, Department of Anesthesia, New York University Hospital for Joint Disease, New York, NY; Sandra Hardy, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY
E110
American Journal of Infection Control June 2010
Background: Although the effectiveness of reducing Staphylococcus aureus (SA) colonization prior to surgery on surgical site infection (SSI) rates has been well studied, patient attitudes toward and tolerance of SA eradication regimens have not been assessed. Our orthopedic specialty hospital’s Pre Admission Testing (PAT) clinic instructs patients undergoing total joint arthroplasty or spine surgery to purchase a chlorhexidine gluconate (CHG) containing soap and prescribes intranasal mupirocin ointment (MO). Patients receive standardized instructions on use of the CHG/MO prior to surgery. Objective: The study assessed: compliance with and determining the ease of following a standardized protocol, and the financial burden to the patient. Methods: 146 patients who underwent orthopedic surgeries received the anonymous survey questionnaire. Participating patients returned the questionnaire to their nurse before discharge. Descriptive statistics were used to analyze the survey. Results: d 100/146 (68%) returned the survey d Mean age was 55 years (range 19-85) d 50 (50%) were female d 85/ 100 (85%) attended PAT and received the MO/CHG protocol d 14/100 (14%) did not attend PAT; of these, 12 (12%) did not receive the MO/CHG protocol and 2 (2%) received the MO/CHG protocol from their provider d 1/100 (1%) was unable to recall PAT attendance d Of the PAT attendees: A) 69/85 (81%) followed the protocol for MO use (MO users) B) 37 (54%) MO users reported an out of pocket (OOP) expense; mean $31 (range $2-$115) C) 9 (13%) MO users reported the OOP expense was a hard or very hard financial burden D) (6%) MO users reported difficulty locating MO. 76/85 (89%) followed protocol for CHG use (CHG users) A) 71 (84%) CHG users reported the protocol was easy or very easy to follow d 46% of respondents stated concern about acquiring a SSI Conclusions: 80% of patients who received the SA SSI Prevention protocol were fully compliant, in spite of a direct cost and/or difficulty in obtaining MO- illustrating patient concern with SSI and a willingness to participate in infection prevention efforts. Given the barriers to obtaining and paying for MO, and some difficulty with applying CHG, compliance may be improved if MO is provided to patients with high OOP expenses and the method of CHG application is simplified. To our knowledge, this is the first effort to determine patient attitudes towards a preoperative SA colonization reduction regime.
Presentation Number 12-139
Use of Trained Student Volunteers to Assess Adherence to Hand Hygiene Guidelines by Healthcare Workers Susan Boeker, BSN, RN, CIC, Infection Preventionist; J. William Kelly, MD, Hospital Epidemiologist; Connie Steed, MSN, RN, CIC, Director of Infection Prevention & Control, Greenville Hospital System, Greenville, SC Issue: Direct observation of practices of healthcare workers (HCW) along with appropriate feedback, has traditionally been a cornerstone of programs to improve hand hygiene adherence. This is a labor intensive process, requiring a time commitment beyond the capability of most busy Infection Preventionists (IP). In addition, it has been argued that the consistent use of known IP may introduce an observational bias commonly referred to as the Hawthorne Effect. For several years, our institution has used nurses from the Supplemental Staffing Team (SST) to do these hand hygiene observations. These nurses have no other IP at the time they are observing and are generally not recognized as part of the IP teams. Each summer, our institution employs a group of student volunteers from local high schools. We describe a project to assess the use of these teen volunteers to augment the SST nurses. Project: The student volunteers (SV) were trained in a four hour, one-on-one session by an experienced IP. As part of the training, they made independent observations of hand hygiene adherence that were validated by the IP trainer. In all cases there was excellent correlation of SV and IP observations. The SV were assigned to units throughout the institution to observe hand hygiene adherence. During the same period the SST nurses were continuing their observations as before. The results of the observations by the SV’s and SST’s were compared. Results: The SV’s made observations over a two month period. They found that nurses disinfected hand following patient care during 52.3% of observations. During the same interval SST’s recorded 96.3% adherence. The month after the SV’s left IP’s noted 80% adherence while SST found 90.3% (table 1).
E109
Results: The total number of SSIs decreased in 2009. Craniotomy infections in patients with a NHSN Risk index 0 or 1 have decreased 46% to date, from 1.93% to 1.04%. Laminectomy infections among patients with a risk index of 0 or 1 have decreased 23%, from 1.55% to 1.2%. There is improved compliance with proper surgical hand scrubbing, incision site washing and prepping, antibiotic prophylaxis timing, and sterile field maintenance. Lessons Learned: SSI prevention is critical to improving patient safety. Engaging all stakeholders, empowering a task force to develop guidelines, facilitating ownership of the process by all involved and creating a cooperative spirit during implementation has moved us closer to the goal of zero infections. Presentation Number 12-137
Squeaky Clean Hands Result from Child/Family Directed Care Barbara J. Simmonds, RN, BS, CIC, Director, Miami Children’s Hospital, Miami, FL Issue: Patient-directed care was the guiding philosophy in our commitment to achieve the critical patient safety goal of hand hygiene. IHI states that in spite of well-established hand hygiene standards, procedures are only followed by health care staff approximately 50% of the time, facilitating the transmission of health-care-associated pathogens to patients. This presentation will demonstrate one organization’s journey to bring the first line of defense to life with involvement of children and families to direct care. This multi-pronged approach could easily be replicated in other settings. Project: In 2008, under the direction of members of the Family Advisory and Teen Advisory Councils, the 282-bed, acute-care, free-standing children’s hospital began the SQUEAKY CLEAN adventure by reviewing the following: dHand hygiene best practices from other children’s hospitals dParent perception of compliance by interviews and direct observation dAnalysis of hand washing dispensers throughout the organization dTypes of product used. Common language was developed with education given to the child/family, on admission, reinforcing that hand washing protects the child’s safety. Housewide staff education was done with scripting of ‘‘I’m washing my hands for your safety; please be sure everyone does the same.’’ The child/family receives a ticket book and can then ‘‘reward’’ the care givers for appropriate hand hygiene by immediately offering a ‘‘ticket’’ in recognition of performing hand hygiene. Tickets are accumulated by staff and may be turned in for rewards. The child/family also redeems the empty ticket book for a prize on discharge. ‘‘Take-home’’ hand-hygiene education is given to the child/family. The children enjoy giving out tickets allowing them to control their unfamiliar environment. The staff members are engaged as the children distribute ‘‘rewards’’ or remind them to wash their hands. In 2009 SQUEAKY CLEAN was extended to the offcampus sites. Results: Compliance rates over the last 4 quarters show our goal of 4.5 was met. Lessons Learned: Children/Families eagerly engage in their own care, becoming partners toward a common goal with the healthcare workers. This program gives the patient ‘‘permission’’ to speak up and be assured of SQUEAKY CLEAN HANDS! Presentation Number 12-138
Surgical Site Infection Prevention Initiative: Patient Attitude and Compliance Faith Skeete, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY; Nancy Berger, RN; Kandy Kraemer, RN, Perioperative Services; Louise Comeau, DNP, Acute Surgical Services, New York University Hospital for Joint Disease, New York, NY; Michael Phillips, MD, Hospital Epidemiologist, New York University Langone Medical Center, New York, NY; Janet Haas, DNSc, Director, Infection Prevention and Control, Westchester Medical Center, Valhalla, NY; Steven Bock, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY; Joseph Bosco, MD, Department of Orhtopedics; Andrew Rosenberg, MD, Department of Anesthesia, New York University Hospital for Joint Disease, New York, NY; Sandra Hardy, RN, Infection Prevention and Control, New York University Langone Medical Center, New York, NY
E110
American Journal of Infection Control June 2010
Background: Although the effectiveness of reducing Staphylococcus aureus (SA) colonization prior to surgery on surgical site infection (SSI) rates has been well studied, patient attitudes toward and tolerance of SA eradication regimens have not been assessed. Our orthopedic specialty hospital’s Pre Admission Testing (PAT) clinic instructs patients undergoing total joint arthroplasty or spine surgery to purchase a chlorhexidine gluconate (CHG) containing soap and prescribes intranasal mupirocin ointment (MO). Patients receive standardized instructions on use of the CHG/MO prior to surgery. Objective: The study assessed: compliance with and determining the ease of following a standardized protocol, and the financial burden to the patient. Methods: 146 patients who underwent orthopedic surgeries received the anonymous survey questionnaire. Participating patients returned the questionnaire to their nurse before discharge. Descriptive statistics were used to analyze the survey. Results: d 100/146 (68%) returned the survey d Mean age was 55 years (range 19-85) d 50 (50%) were female d 85/ 100 (85%) attended PAT and received the MO/CHG protocol d 14/100 (14%) did not attend PAT; of these, 12 (12%) did not receive the MO/CHG protocol and 2 (2%) received the MO/CHG protocol from their provider d 1/100 (1%) was unable to recall PAT attendance d Of the PAT attendees: A) 69/85 (81%) followed the protocol for MO use (MO users) B) 37 (54%) MO users reported an out of pocket (OOP) expense; mean $31 (range $2-$115) C) 9 (13%) MO users reported the OOP expense was a hard or very hard financial burden D) (6%) MO users reported difficulty locating MO. 76/85 (89%) followed protocol for CHG use (CHG users) A) 71 (84%) CHG users reported the protocol was easy or very easy to follow d 46% of respondents stated concern about acquiring a SSI Conclusions: 80% of patients who received the SA SSI Prevention protocol were fully compliant, in spite of a direct cost and/or difficulty in obtaining MO- illustrating patient concern with SSI and a willingness to participate in infection prevention efforts. Given the barriers to obtaining and paying for MO, and some difficulty with applying CHG, compliance may be improved if MO is provided to patients with high OOP expenses and the method of CHG application is simplified. To our knowledge, this is the first effort to determine patient attitudes towards a preoperative SA colonization reduction regime.
Presentation Number 12-139
Use of Trained Student Volunteers to Assess Adherence to Hand Hygiene Guidelines by Healthcare Workers Susan Boeker, BSN, RN, CIC, Infection Preventionist; J. William Kelly, MD, Hospital Epidemiologist; Connie Steed, MSN, RN, CIC, Director of Infection Prevention & Control, Greenville Hospital System, Greenville, SC Issue: Direct observation of practices of healthcare workers (HCW) along with appropriate feedback, has traditionally been a cornerstone of programs to improve hand hygiene adherence. This is a labor intensive process, requiring a time commitment beyond the capability of most busy Infection Preventionists (IP). In addition, it has been argued that the consistent use of known IP may introduce an observational bias commonly referred to as the Hawthorne Effect. For several years, our institution has used nurses from the Supplemental Staffing Team (SST) to do these hand hygiene observations. These nurses have no other IP at the time they are observing and are generally not recognized as part of the IP teams. Each summer, our institution employs a group of student volunteers from local high schools. We describe a project to assess the use of these teen volunteers to augment the SST nurses. Project: The student volunteers (SV) were trained in a four hour, one-on-one session by an experienced IP. As part of the training, they made independent observations of hand hygiene adherence that were validated by the IP trainer. In all cases there was excellent correlation of SV and IP observations. The SV were assigned to units throughout the institution to observe hand hygiene adherence. During the same period the SST nurses were continuing their observations as before. The results of the observations by the SV’s and SST’s were compared. Results: The SV’s made observations over a two month period. They found that nurses disinfected hand following patient care during 52.3% of observations. During the same interval SST’s recorded 96.3% adherence. The month after the SV’s left IP’s noted 80% adherence while SST found 90.3% (table 1).