Each year since 2009, the World Health Organization (WHO) has hosted a global hand hygiene campaign on May 5. This call to action is focused on hand hygiene at the point of care as the “entrance door” to the larger goal of preventing healthcare-associated infections (HAIs). At Proventix, we believe that hand hygiene is a keystone behavior that promotes a larger culture of quality and safety and we are excited about the global hand hygiene focus on May 5th! How will your organization be participating? WHO provides several resources for healthcare workers, administrators and communities. If you participate, don’t forget to share on social media and use #safeHANDS
Currently, most hospitals isolate patients with infections such as MRSA. This practice can cost millions annually and often results in patient anxiety, depression and fewer visits by healthcare workers. A study by Virginia Commonwealth University shows that infection rates can be drastically reduced by simply increasing hand hygiene compliance, saving the hospital money and reducing the need for patient isolation. The 2012 study shows a 95% reduction in MRSA infections over a nine year period.
Sustaining high levels of hand hygiene compliance has been a challenge for more than 150 years and subject to great study. In summary, we all know hand hygiene is the number 1 way to prevent the spread of infection diseases in our healthcare institutions and communities.
Healthcare professionals have experienced that there is not a singular fix and most would reasonably accept that improvements require a multimodal approach. Part of the Proventix multimodal approach includes engaging the patients and their visitors into the culture of safety.
Over this past year, Proventix has received various letters expressing gratitude for our solution. A healthcare executive from a neighbor facility visiting a loved one in a Proventix partner hospital wrote,
“I recognized the staff’s demonstration of excellence with High levels of hand hygiene compliance. Well Done! As a healthcare executive I know how hard it is….”
“Can you come talk to our facility about Proventix? I saw it in use while visiting one of my family members in … Hospital.”
Just last week, we received an email from a friend of a patient at a Proventix monitored hospital.
“I am personally requesting information. I had a friend pass away at _____ Hospital in _________. She had cancer and before she died she asked me to get one of your hand washing w/LCD screen with the trivia readout for her husband for Christmas. I know this is an unusual request but I promised I try. I didn’t realize that it is not common place and you can’t find to buy over the counter. Is there any way I can purchase a system from you or another distributor? Thank you for your time and consideration. “
After receiving this note and talking to the friend of the patient, we learned that the patient preferred a quiet room and the trivia messages displayed after each hand hygiene event not only helped keep her safe but allowed all the family members to have something to talk about and create some levity. Even the 5 year old family member was engaged in hand washing because of the enjoyment of watching the new messages appear on the screen while she washed her hands.
In response to this particular note, Proventix sent a Communications Unit (CU) with custom messaging to the patient’s husband and family. A button under the CU will allow them to change the messages and view various trivia messages based on his personal interests. Our team was touched by this request, and is honored to provide this gift.
Our data shows that the hand hygiene of visitors and patients increases when healthcare workers demonstrate leadership and diligence.
Wishing you and yours a happy and healthy holiday season. We look forward to continuing to serve our customers, their patients, and their patients’ loved ones in 2014.
CEO & Founder Proventix Systems
In today’s world, knowledge is abundant in every field, and we have vast amounts of information to make our lives easier that was unavailable just a few decades ago. This amount of knowledge has also complicated processes and systems, and healthcare is no exception. Atul Gawande, surgeon and health journalist, presented a TEDTalk in March of 2012 titled “How do we heal medicine?” where he discussed the complexity of healthcare and how to improve systems in healthcare.
The healthcare field has compartmentalized as it has progressed. Physicians are now highly specialized and skill sets are grouped into smaller components. However, to make healthcare work, having isolated specialties and health components is not good enough. So how do we make systems work in healthcare, particularly in infection prevention? The components must come together and function as a system. To do that, Gawande recognizes that a good system capitalizes on three skills.
First, a good system has the ability to recognize successes and failures. This can only be done by paying attention to data and measuring outcomes, because you can’t know what you don’t measure. In infection prevention, measuring outcomes will help infection preventionists recognize which interventions work and which are less effective, helping them target the most effective interventions.
Second, a good system has the ability to devise solutions to address failures. Gawande specifically discusses checklists and their ability to be implemented in healthcare to improve processes. These are the same types of checklists that are used in the aviation and high-rise industries to handle the complexity of tasks and to ensure that high-risk activities follow the necessary processes for the best outcomes. Gawande’s work with checklists among surgical teams has shown that they have the ability to drastically reduce mistakes and improve outcomes. Infection prevention teams can benefit from these same checklists by identifying key steps in a process that must not be skipped when caring for a patient.
Third, a good system has the ability to implement the solutions that they have discovered. We are taught that in order to be successful we should value independence, self-sufficiency and autonomy. These values directly conflict with the idea of working with others as a group. Gawande feels that this is why checklists are currently underutilized in healthcare, despite his proof that they work. He points out that values like humility, discipline and teamwork help contribute to group success and can help teams work toward a common goal.
To watch Gawande’s TEDTalk, visit: http://www.ted.com/playlists/70/what_doctors_worry_about.html
As mentioned in our previous blog, the Senate Health, Education and Labor Pensions Committee held a hearing on national efforts to reduce healthcare-associated infections (HAIs). While hospitals continue to make progress in reducing preventable patient errors and deaths, more than 200,000 patient preventable deaths are still occurring each year in U.S. hospitals. The Patient Safety Movement Foundation, established to bring all stakeholders together to address patient safety, committed to a goal of zero preventable patient deaths by the year 2020. Joe Kiani, founder of the Patient Safety Movement Foundation, spoke before the committee and offered his recommendations for eliminating preventable patient deaths. He provided five ways that stakeholders can work together to boldly address the problem of preventable patient deaths:
Create a system of transparency – We can only estimate the number of preventable patient deaths and the causes since hospitals are not required to measure and report these preventable deaths. Kiani recommends that the government create standardized processes for hospitals to define, measure, and report both HAIs and healthcare-acquired conditions (HACs). In addition to having a standardized measurement and reporting system, he suggests that these rates be publically reported for accountability.
Provide incentives and disincentives – In addition to recommending expansion of Medicare policies to decrease reimbursements for causes of preventable deaths, Kiani also recommends providing incentives for hospitals by suggesting that hospitals should be shielded from malpractice lawsuits if they implement evidence-based practices to decrease preventable patient deaths.
Create the “patient data super highway” – Medical technologies tend to operate in isolation and do not share data openly with each other. Kiani recommends that technology systems be required to share information with each other for improved efficiency and transparency of outcomes.
Extend safe harbors – Currently, hospitals are protected by safe harbor laws for reporting adverse events to patient safety organizations. To promote transparency, Kiani suggests that Congress should expand these legal safe harbors to technology vendors as well.
Ensure patient dignity – Hospitals need to include patients and their families as partners in care and advocate on behalf of their experience. Kiani proposes having a patient care advocate at every hospital.
What do you think about Kiani’s suggestions to get to zero preventable patient deaths by 2020? Are there other ways that you have seen stakeholders work together to improve outcomes with patient preventable deaths?
Since the 1800s, the topics of patient safety and preventing infections have been known among healthcare workers and healthcare facilities. In the 1970s, the Centers for Disease Control and Prevention (CDC) recognized the need for infection prevention in healthcare settings and over the years, they along with hospital regulators and inspection agencies, have increased the information and regulations required of hospitals to improve safety and hand hygiene. In 2005, the Deficit Reduction Act was put in place and in October 2008, reimbursement changes to hospitals from the Centers for Medicare and Medicaid (CMS) attempted to address some of these negative hospital acquired conditions including healthcare-associated infections (HAIs). Lower reimbursements penalized hospitals for infections and other conditions the elderly Medicare patients acquired during the hospital stay. Today, the Department of Health and Human Services (HHS) requires measurement of patient satisfaction through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and the results are starting to impact hospital inpatient reimbursement.
But are lower hospital reimbursements and penalties the best methods for improving patient safety? Lower reimbursements negatively impact the entire hospital by the errors of caregivers. These errors can cause death or extreme pain and suffering with the patient, and the patient’s family and healthcare workers are also impacted. However, the current solutions to increase patient safety driven by human efforts in a service industry are difficult.
On September 24, 2013, four leaders spoke at a hearing before the Senate Health, Education, Labor and Pensions Committee on U.S. efforts to reduce HAIs. These leaders discussed the improvements made in reducing infections as well as the systems and processes that have been and potentially could be put in place to increase safety.
What will be the outcome of this discussion? As the Senate hearing relayed, the government has tried to increase patient safety through increased funding for better record keeping and communication through healthcare information technology, procedure checklists and the negative reimbursements mentioned earlier. Many of the solutions have helped improve patient outcomes, but are there other processes and technologies that can help even more? Solutions that help caregivers communicate and remember to apply all the safety processes, including hand hygiene, can go far in achieving better patient and caregiver outcomes. Perhaps government and private insurers can focus on increased rewards for healthcare organizations and caregivers that apply the evidence-based practices for sustainability of increased patient safety and care.
Becker’s Clinical Quality and Infection Control recently featured a study published in Infection Control and Hospital Epidemiology that explored the most common barriers to hand hygiene compliance. In the study, 123 healthcare workers in a Thai hospital were observed for compliance with the World Health Organization’s “five moments” of hand hygiene. Based on direct observation, their hand hygiene compliance was 23.2%, but the participants self-reported their compliance at 82.4%. Participants were also surveyed on why they failed to perform hand hygiene compliance.
Below are the participants’ responses for why they failed to perform hand hygiene practices and how these barriers can be overcome.
- “I hurry/emergent patient conditions” (45.5%) – With the advent of alcohol-based hand sanitizer, hands can be cleansed with a quick dispense and rubbed on the way to patient care in a few seconds’ time. While sanitizer is not appropriate in all situations since C. diff is not affected by sanitizer, sanitizer makes it easier in appropriate situations for the healthcare worker to perform hand hygiene.
- “I don’t see any dirt/I think it’s not dirty” (24.4%) – Touch is one of the biggest ways that infections spread. Bacteria and viruses are invisible to the eye but can be easily transferred between patient care to equipment and back to other patients. Following recommended hand hygiene protocols before entry and after exit of a patient room ensures that hands are clean, even if they do not appear to be dirty.
- “I forget” (19.5%) – Healthcare workers have many duties and responsibilities on their mind. With so many demands during the day, it is easy to forget a task if it is not an established habit. By creating a habit of hand cleansing at a minimum on every entry into and exit from patient rooms, hand hygiene is added to a routine and is not as hard to remember.
- “I’m busy/too many patients” (15.4%) – While it can seem that skipping hand hygiene will allow a healthcare worker more time with patients, a patient who gets an infection while in the hospital increases the time and cost of treating that patient, and these negative outcomes override the few seconds needed to cleanse hands.
- “It is inconvenient” (13.8%) – Again, the advent of alcohol-based hand sanitizer allows hand sanitizers to be placed anywhere in the hospital and not just around a sink, meaning that hospitals can be flexible and place sanitizers in locations that are most convenient to healthcare worker workflow.
- “I don’t care” (8.1%) – Hand hygiene is a standard of care, and healthcare workers have a professional responsibility to provide the highest level of safe and quality care. Management at the hospital can support healthcare workers on all levels by setting an example for hand hygiene and encouraging high compliance on the individual and unit level.
- “I’m lazy” (5.7%) – Similar to the above statement, hand hygiene is a standard of care and cannot be excused for laziness when patient safety is on the line. Management can create a hospital culture where hand hygiene is non-negotiable, while at the same time supporting healthcare workers who are making efforts to improve hand hygiene compliance.
- “I wear gloves/no direct contact with patients” (4.9%) – Hands should be cleansed before donning gloves. Gloves protect the healthcare worker more than they do the patient. Even if a healthcare worker does not touch the patient, the environments both inside and outside the patient rooms are not sterile and touching these surfaces contaminates both gloves and hands.
- “There are adverse effects of soap/cleanser” (4.9%) – Frequent sanitizing often causes hands to dry out, but washing with soap and water every third or fourth time after using alcohol-based sanitizer helps alleviate these adverse effects. Many manufacturers also provide lotions and moisturizing formulas of sanitizer to help combat drying.
- “It wastes time” (4.1%) – Patient safety is never a waste of time and should always be a high priority. Hand hygiene is known as one of the best ways to prevent the spread of infections.
- “My hands are clean” (2.4%) – This statement is similar to saying that hands do not look or feel dirty, since you cannot see the germs that cause infections. It is also easy to unconsciously touch something that is contaminated between cleansings and not have remembered, which is why it is important to cleanse at entry and exit of a patient room.
With the appropriate workflow, encouragement, leadership, training, behavioral changes and the right tools, many of these barriers can be overcome. However, some of these barriers – “I don’t care” or “I’m lazy” – point to a larger problem of priorities and the need for professional responsibility to the patient and their care. Each hospital’s culture is different, but recognizing the culture and addressing these barriers in a way that speaks to the healthcare workers at the hospital can create a culture supportive of hand hygiene.
The Institute of Medicine estimates that 98,000 Americans die each year from preventable medical errors. Causes of medical errors are categorized based on errors of commission, errors of omission, errors of communication, errors of context, and diagnostic errors. Since the Institute of Medicine’s estimate is based on data from 1984, researchers decided that an updated analysis was needed. In a study published last month in the Journal of Patient Safety, researchers determined that using a weighted average from four modern studies published from 2008 to 2011, a lower limit of 210,000 deaths per year was associated with preventable harm in US hospitals. However, despite the lower limit, researchers estimate that the actual number could be closer to an estimated 400,000 per year, given the limitations of the study. This number is much higher than originally estimated by the Institute of Medicine. To read the full study, click here.
Around the same time that these new statistics were released, Forbes reported that thought leaders and stakeholders from all areas that influence healthcare gathered at the inaugural Form on Emerging Topics in Patient Safety, jointly sponsored by the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the World Health Organization. Captain Chelsey B. “Sully” Sullenberger, known as the pilot who successfully performed an emergency water landing in the Hudson River in 2009, delivered the keynote address and pointed out that the same strategies that helped save lives on the Hudson River can and should be applied in healthcare to improve patient safety. Other speakers from fields such as aerospace, defense, education, hospitality and nuclear power, shared their own challenges with safety. Discussions focused on how the healthcare industry can design safe and “highly reliable systems of care delivery”, something that has been championed by Dr. Peter Pronovost, Johns Hopkins Medicine Senior Vice President for Patient Safety and Quality and one of the preeminent thought leaders and advocates for patient safety. These discussions pointed out that many existing technologies and processes have been proven in their industries and can be applied to healthcare to improve safety and quality of care, with the ultimate goal of reducing the annual deaths per year due to preventable medical errors.
Earlier this month, Alicia Caramenico with FierceHealthcare posted an editorial on the “3 ways to fight hospital infections”. In light of the recent research published by JAMA Internal Medicine that healthcare-associated infections (HAIs) cost $9.8 billion per year, this well-timed editorial highlights three infection prevention strategies that are worth investing in to help fight HAIs, prevent suffering and bring healthcare costs down.
Teamwork – It goes without saying that a unified effort produces much greater results than individuals acting alone. Studies show that people learn more at play. Injecting fun into team efforts through unit competitions is a great way to unify everyone toward a common goal.
Technology - Hospitals can utilize technology to assist with existing infection prevention efforts. Technology systems play an increasing role in infection prevention and can assist with hospital workflow and practices, allowing healthcare workers to spend more time on patient care.
Education – Robust infection prevention policies and continued education for hospital staff are cited as key strategies to use for preventing infections. Education efforts directed toward hospital patients are also an important way of engaging patients in the infection prevention program and can create a dialogue between hospital staff and patients around hand hygiene and patient safety.
These three ideas are just the starting point, and hospitals have come up with their own innovative ways of preventing infections. What other infection prevention strategies do you believe are worth investing in?
Check out the full FierceHealthcare editorial for links to studies and examples of successful hospital initiatives.
The CDC has released two findings on healthcare-associated infections this week, one bringing alarming news and the other encouraging news to the infection control community.
On Monday, the CDC released its first-ever report on antibiotic-resistant infections. The report says that each year in the United States, at least two million people are infected with bacteria that are resistant to one or more types of antibiotics. Of these two million people, at least 23,000 die annually from these antibiotic-resistant infections. However, these deaths are just a baseline, as many other people die from other conditions that were complicated by an antibiotic-resistant infection. According to the report, the top three infections considered to be “urgent” threats because of their human and economic impacts are: CRE, C. difficile, and drug-resistant gonorrhea. The findings in the CDC report emphasize the importance of infection prevention in hospitals and the need to scale up the implementation of strategies already in place to prevent the spread of these antibiotic-resistant infections. To read the full report from the CDC, click here.
In another report out this week, the CDC has indicated that hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection rates have decreased in the last decade, with the number of serious MRSA infections diagnosed while people were in the hospital falling by 54% between 2005 and 2011. This is the equivalent of a decrease of about 9.7 infections per 100,000 people to about 4.5 per 100,000 people. The new study could not conclude why MRSA rates are dropping but noted that the decrease is likely due to infection prevention efforts in hospitals.
Centers for Disease Control and Prevention, Antibiotic resistance threats in the United States, 2013, online September 16, 2013.
JAMA Internal Medicine, online September 16, 2013.