Friday, September 16, 2016

Hand Hygiene

Published in VC's Notes on September 16, 2016

Moving the Numbers on Hand Hygiene

Good morning!

I want to start with a big “thank you” for your efforts to improve hand hygiene across the organization.

In Leadership Rounds this week, we heard that our overall hand hygiene compliance has now reached 70 percent.  We're still striving toward our goal of 80 percent compliance by the end of the 2016 calendar year, but when you consider where we started just about a year ago - at 54 percent - I am very encouraged that we are embracing this challenge.

I'm also confident these data are real, since they're based on a “secret shopper” methodology we implemented last year.  In this system, 100 trained members of our own workforce make more than 3,000 discreet observations per month.  These data are standardized and posted along with other quality metrics on the Clinical Intranet for all to see.  

Hand Hygiene 9 2016Kudos to those units that have had especially strong performance, including the NICU, pediatrics and the adult ICUs.    

Hand hygiene is linked, along with other factors, to hospital-acquired infections.  While we have not seen sustained overall improvement in HAIs yet, evidence indicates that improved hand hygiene correlates with lower infection rates over a period of years.

This speaks to an important point.  Good hand hygiene is a desired practice in and of itself, but it's also a marker of an HRO - a high reliability organization.  Members of these organizations do the right things without thinking - their behaviors are engrained.  They would never think of not washing their hands before and after an encounter with the patient; it wouldn't feel right.  Correct practice becomes a matter of personal integrity as well as organizational culture.

Recently I had the opportunity to hear a discussion of hand hygiene best practices by Dr. Jason Parham, associate professor of medicine and the medical director of our Antimicrobial Stewardship Program.  Jason is a “Hand Hygiene Warrior!”  Here are three tips he shares with colleagues, in his own words:  

1. Foam in and out of every patient room you enter. If you break the plane of the doorway, you must perform hand hygiene every time, without fail. Every time we enter a room we must be prepared to administer care to our patient, so our hands must be clean. Unexpected things happen - passing a tissue box after bad news, hugging a family member, picking up the call light from the floor, repositioning the bedside tray - and all of these can lead to spread of germs. Be ready to care every time through the door.

2. If it is a “C diff” patient, use soap and water. For all others, foaming is at least as effective, is easier on your hands and is less time-consuming.

3. Before putting on gloves and after removing them, practice hand hygiene. Studies have shown that if we don't wash, we contaminate the gloves with germs while putting them on, and our hands when taking them off.  And, of course, we don't keep gloves on when going from room to room.

That kind of focus on best practices is improving our scores.  If you have not done so, I encourage you to visit the Enterprise Quality Scorecard in the upper left part of our Clinical Intranet home page.  There you can track our progress on our seven major quality metrics. On the hand hygiene data, you can drill all the way down to the provider level by clicking on the little red box.  (If the Clinical Intranet is not your browser home page, click the “Healthcare” tab in the blue horizontal navigation bar on the UMMC Intranet to access it.)

The numbers presented in the scorecard are important.  They are, in effect, our grades - grades that will help determine our reimbursement and, increasingly, whether patients can trust us to provide their care.  

But they don't tell the whole story.  I hear the rest of the story when I make rounds and nurses and others on the units tell me, in so many words, how important quality and patient safety are to them, even though they clearly have a hundred other things to worry about.  I hear it in clinical department quality reviews when I see the level of engagement and commitment demonstrated by our faculty leaders.  The numbers are important, but they are only a representation of what we do, every day, to put our patients' welfare at the center of our world.

We are making progress.  We are moving the numbers on quality.  Let's keep them moving in the direction of A Healthier Mississippi. 

 



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