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To Ask or not to Ask? The Question of Patients Asking Healthcare Personnel to Perform Hand Hygiene: Results: of a Formative Assessment of a Hand Hygiene Video
www.ajicjournal.org Vol. 37 No. 5
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Washington hospitals in their efforts to meet Centers for Disease Control isolation guidelines. The work involved developing signage standards that were acceptable to all participants and applicable to all settings, and templates for signage that would enable staff to provide safe care and patients and families to understand their roles in preventing disease transmission. The taskforce met 4 times to a) evaluate existing isolation practices and signage, b) discuss the isolation needs of various the populations represented, and c) develop a signage system. Draft products were reviewed by end users at the hospitals and their feedback was incorporated into the final products. Results: Over a 6 month period, the taskforce reached consensus on a package of 7 isolation signs: Standard, 5 transmission-based, and 1 ‘‘Special’’ precautions. (see example below) Isolation requirements on the signs were based on the 2007 CDC isolation guidelines. Additional guidance on implementation of isolation, patient transport instructions, and how to don and remove isolation gear was developed for placement on the reverse of the signs. The taskforce also developed a toolkit to be used for implementation of the signage that included educational materials for staff and rationales to support the change. Lessons Learned: Reaching consensus on approaches to practice within a group of hospitals with widely divergent patient populations (pediatrics, adults, veterans, trauma) was challenging even when beginning with a set of national guidelines. Input from end users was critical to the process. Consistent effort over time and strong collaboration skills were essential components of the work.
Presentation Number: 11-139
To Ask or not to Ask? The Question of Patients Asking Healthcare Personnel to Perform Hand Hygiene: Results: of a Formative Assessment of a Hand Hygiene Video Amanda Garcia-Williams, MPH, Kristin Brinsley-Rainisch, MPH, Sarah Schillie, MD, MPH, MBA, Ronda Sinkowitz-Cochran, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA Background: Patient empowerment programs have been shown to improve healthcare personnel (HCP) hand hygiene (HH) compliance. A five-minute educational video (‘‘Hand Hygiene Saves Lives’’) was developed to encourage patients and family members to perform HH and ask their HCP to perform HH as well. Methods: Four focus groups were conducted in February 2008 to formatively evaluate the video as well as perceptions of healthcare-associated infections (HAIs) and HH. Participants included lay persons (LP) with recent hospital exposure (i.e., patient or family member in hospital in past year), LP without recent hospital exposure, nurses, and physicians. Likert scales ranging from 1 [not at all] to 5 [very] were used for several items in the script. Qualitative data were coded and analyzed for themes.
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Results: A total of 35 individuals participated in four focus groups (LP: n 5 18, HCP: n 5 17). Overall, participants perceived HAIs to be somewhat common (Mean 3.4, Range 2-5) and believed HH was very important (Mean 4.9, Range 3-5). HCP reported that accessibility issues (36.8%), skin irritation (31.6%), and lack of time (26.3%) were the primary barriers to HH. Before watching the video, LP were reportedly somewhat less likely to ask their nurse to perform HH (Mean 2.5, Range 1-5) than their physician (Mean 3.3, Range 1-5). HCP reported that they would be comfortable being asked; however, their comfort would be situation-dependent. After watching the video, LP reportedly were significantly more likely to ask their nurses (p 5 0.001) and their physicians (p 5 0.010) to perform HH as compared to before. Across all four groups, the target audience of the video was perceived to be families (42.0%), patients (39.4%), or HCP (18.8%), and the message was perceived to be the importance of HH (45.5%), creating comfort about asking (24.2%), or not spreading germs (21.2%). Suggested locations for playing the video included admission/waiting rooms (50.0%), pre-admission areas (23.8%), or on a hospital TV channel (11.9%). Participants preferred hand sanitizer product (36.4%) and visual reminders or ‘‘signage’’ (20.5%) to accompany the video. Conclusions: A video may be an effective tool to increase LP likelihood of asking their HCP to perform HH. The perceived target audience and message of the video also may increase LP likelihood of asking. Encouraging patients to ask their HCP to perform HH may be an important influence on improving HH in healthcare settings.
Presentation Number: 11-140 Blue Ribbon Award Winner
To Buff or Not to Buff, That is the Question Lee Sholtz, RN, MSN, CIC, Infection Control Specialist; Nedra Marion, RN, BSN, MPA, CIC, Manager; Paul Turner, CHESP, Director; Mark E. Rupp, MD, Medical Director, The Nebraska Medical Center, Omaha, NE Issue: The public associates a shiny floor with an aseptic, safe environment. However, achieving a shiny floor surface requires environmental service (EVS) workers to wax and buff the floor. While performing air particle counts as part of our construction risk minimization program, elevated air particulate counts were identified near patient room floor buffing. Does floor buffing create additional risk or unanticipated adverse events? Project: Three hospital patient rooms were studied during routine floor treatment. The floors were dry mopped to collect dust, wet mopped with a disinfectant solution, and buffed wet by EVS. Air particulate counts (2-5 microns) were taken inside the patient room before, during, and after floor buffing. Simultaneously, quantitative fungal air cultures were performed by sampling 0.566 m3 of air at each timepoint on Sabouraud agar plates. Plates were incubated for ten days then analyzed for fungal colony forming units (CFU) and species identification. Results: Elevated particulate counts were identified during floor buffing in all rooms (figure 1). The mean particle count increased from a baseline of 10,857 6 4637 to 70,325 6 18,311 during the floor buffing procedure (p 5 0.017). Immediately following the buffing procedure, the particle count decreased to a mean value of 26,258 6 9562 (P 5 NS compared to baseline). The mean number of airborne fungi increased from 2.3 CFU/m3 at baseline to 6.4 CFU/m3 during buffing and 4.1 CFU/m3 immediately after buffing (P 5 NS). Environmental fungi such as Penicillium species were most frequently observed.
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Washington hospitals in their efforts to meet Centers for Disease Control isolation guidelines. The work involved developing signage standards that were acceptable to all participants and applicable to all settings, and templates for signage that would enable staff to provide safe care and patients and families to understand their roles in preventing disease transmission. The taskforce met 4 times to a) evaluate existing isolation practices and signage, b) discuss the isolation needs of various the populations represented, and c) develop a signage system. Draft products were reviewed by end users at the hospitals and their feedback was incorporated into the final products. Results: Over a 6 month period, the taskforce reached consensus on a package of 7 isolation signs: Standard, 5 transmission-based, and 1 ‘‘Special’’ precautions. (see example below) Isolation requirements on the signs were based on the 2007 CDC isolation guidelines. Additional guidance on implementation of isolation, patient transport instructions, and how to don and remove isolation gear was developed for placement on the reverse of the signs. The taskforce also developed a toolkit to be used for implementation of the signage that included educational materials for staff and rationales to support the change. Lessons Learned: Reaching consensus on approaches to practice within a group of hospitals with widely divergent patient populations (pediatrics, adults, veterans, trauma) was challenging even when beginning with a set of national guidelines. Input from end users was critical to the process. Consistent effort over time and strong collaboration skills were essential components of the work.
Presentation Number: 11-139
To Ask or not to Ask? The Question of Patients Asking Healthcare Personnel to Perform Hand Hygiene: Results: of a Formative Assessment of a Hand Hygiene Video Amanda Garcia-Williams, MPH, Kristin Brinsley-Rainisch, MPH, Sarah Schillie, MD, MPH, MBA, Ronda Sinkowitz-Cochran, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA Background: Patient empowerment programs have been shown to improve healthcare personnel (HCP) hand hygiene (HH) compliance. A five-minute educational video (‘‘Hand Hygiene Saves Lives’’) was developed to encourage patients and family members to perform HH and ask their HCP to perform HH as well. Methods: Four focus groups were conducted in February 2008 to formatively evaluate the video as well as perceptions of healthcare-associated infections (HAIs) and HH. Participants included lay persons (LP) with recent hospital exposure (i.e., patient or family member in hospital in past year), LP without recent hospital exposure, nurses, and physicians. Likert scales ranging from 1 [not at all] to 5 [very] were used for several items in the script. Qualitative data were coded and analyzed for themes.
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American Journal of Infection Control June 2009
Results: A total of 35 individuals participated in four focus groups (LP: n 5 18, HCP: n 5 17). Overall, participants perceived HAIs to be somewhat common (Mean 3.4, Range 2-5) and believed HH was very important (Mean 4.9, Range 3-5). HCP reported that accessibility issues (36.8%), skin irritation (31.6%), and lack of time (26.3%) were the primary barriers to HH. Before watching the video, LP were reportedly somewhat less likely to ask their nurse to perform HH (Mean 2.5, Range 1-5) than their physician (Mean 3.3, Range 1-5). HCP reported that they would be comfortable being asked; however, their comfort would be situation-dependent. After watching the video, LP reportedly were significantly more likely to ask their nurses (p 5 0.001) and their physicians (p 5 0.010) to perform HH as compared to before. Across all four groups, the target audience of the video was perceived to be families (42.0%), patients (39.4%), or HCP (18.8%), and the message was perceived to be the importance of HH (45.5%), creating comfort about asking (24.2%), or not spreading germs (21.2%). Suggested locations for playing the video included admission/waiting rooms (50.0%), pre-admission areas (23.8%), or on a hospital TV channel (11.9%). Participants preferred hand sanitizer product (36.4%) and visual reminders or ‘‘signage’’ (20.5%) to accompany the video. Conclusions: A video may be an effective tool to increase LP likelihood of asking their HCP to perform HH. The perceived target audience and message of the video also may increase LP likelihood of asking. Encouraging patients to ask their HCP to perform HH may be an important influence on improving HH in healthcare settings.
Presentation Number: 11-140 Blue Ribbon Award Winner
To Buff or Not to Buff, That is the Question Lee Sholtz, RN, MSN, CIC, Infection Control Specialist; Nedra Marion, RN, BSN, MPA, CIC, Manager; Paul Turner, CHESP, Director; Mark E. Rupp, MD, Medical Director, The Nebraska Medical Center, Omaha, NE Issue: The public associates a shiny floor with an aseptic, safe environment. However, achieving a shiny floor surface requires environmental service (EVS) workers to wax and buff the floor. While performing air particle counts as part of our construction risk minimization program, elevated air particulate counts were identified near patient room floor buffing. Does floor buffing create additional risk or unanticipated adverse events? Project: Three hospital patient rooms were studied during routine floor treatment. The floors were dry mopped to collect dust, wet mopped with a disinfectant solution, and buffed wet by EVS. Air particulate counts (2-5 microns) were taken inside the patient room before, during, and after floor buffing. Simultaneously, quantitative fungal air cultures were performed by sampling 0.566 m3 of air at each timepoint on Sabouraud agar plates. Plates were incubated for ten days then analyzed for fungal colony forming units (CFU) and species identification. Results: Elevated particulate counts were identified during floor buffing in all rooms (figure 1). The mean particle count increased from a baseline of 10,857 6 4637 to 70,325 6 18,311 during the floor buffing procedure (p 5 0.017). Immediately following the buffing procedure, the particle count decreased to a mean value of 26,258 6 9562 (P 5 NS compared to baseline). The mean number of airborne fungi increased from 2.3 CFU/m3 at baseline to 6.4 CFU/m3 during buffing and 4.1 CFU/m3 immediately after buffing (P 5 NS). Environmental fungi such as Penicillium species were most frequently observed.