Demystifying and Responding to
CDC’s Hand Hygiene Guidelines
and JCAHO’s related Patient
Safety Goal for 2004
Presentation...
Presentation Outline
• CDC Guidelines and JCAHO Patient Safety
Goals for 2004
• Summary of the Evidence
• Letter from Dr. ...
CDC Guidelines on Hand Hygiene
• Issued October 25, 2002
• Issued by CDC and others:
– “CDC Healthcare Infection Control P...
Recommendations (44) from
CDC Guidelines
1. Indications for handwashing and hand antisepsis (14)
2. Hand-hygiene technique...
JCAHO Involvement
• JCAHO issued 6 Patient Safety Goals for
2003
• JCAHO added a new one (#7) for 2004:
– 7a: “Comply with...
“Comply with current CDC
hand-hygiene guidelines”
Category IA. Strongly recommended for implementation and strongly
suppor...
JCAHO Patient Safety Goals
• Resources:
– December 2003 Topics in Patient Safety (TIPS)
Newsletter: www.patientsafety.gov/...
The Evidence
• 423 references in CDC Guidelines
– From Laboratory Tests
– From Hospitals
– From Long-term Care Facilities
...
Study of Alcohol Handrub use at
a Long-Term Care Facility
• Compared the 2 units of the facility where
alcohol hand-rubs w...
Study of Alcohol Handrub use at
an Acute Care Facility
• Compared one unit (orthopedic surgery) of a
hospital before and a...
VHA Summary
• Issued by Dr. Roswell in a memo to VISN
Directors dated 12/15/03
• Also issued in December 2003 issue of
TIP...
VHA Summary of
JCAHO-required CDC
Recommendations (19)
I. All Health Care Workers with Direct
Patient Contact (8)
II. Surg...
Summary of VHA Summary (1)
I. All Health Care Workers with Direct Patient
Contact
• Decontaminate hands before and after
t...
Summary of VHA Summary (2)
II. Surgical Hand Hygiene
• Guidance on surgical scrub with soap and water
(e.g., shorter scrub...
Summary of VHA Summary (3)
III. Facility Management: Supplies
• Alcohol at room entrance and/or bedside
• Alcohol availabl...
Summary of VHA Summary (4)
IV. Facility Management: Administrative
Action
• Make HH a priority and provide financial and
a...
Cross-reference
CDC Guidelines on Hand Hygiene
• If you only remember one thing, remember
this: Alcohol hand-rubs are better than soap
and...
Six Sigma Project with 3M
Corporation
• DMAIC
– Define: project charter
– Measure: process map, cause and effect matrix,
–...
What we’re measuring
(in 3 VAMC ICUs)
• Staff compliance (observing staff with checklist
and clipboard)
• Volume of produc...
3M-VHA Six Sigma Team
Members
Dr. Robert Bonello,
Minneapolis VAMC
Kay Clutter, Minneapolis
VAMC
Linda Danko, Infectious
D...
Preliminary Data
• Staff think they’re doing 90% when they’re doing
60%
• Nurses and doctors are better than others (e.g.,...
Some Tentative Opportunities for
Improvement
• Improve availability of and access to appropriate
supplies (make it easier ...
What to do now
• Get alcohol hand-rubs close to patients to make it
convenient to use: in rooms or entrances to rooms,
in ...
Final Thought
• We know what doesn’t work: status quo of
telling people to use soap and water and
doing nothing when they ...
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February 2004 Hand Hygiene Presentation at Meeting of the Veterans Health Administration "Quality Management Integration Council"

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This slide set is almost 10 years old, but it hits some good points. Especially about us knowing what doesn't work to reduce healthcare associated infections, and needing to do things differently. I have a video of this presentation on a VHS tape somewhere and need to figure out how to get it on YouTube like one I did at the conclusion of the Six Sigma Project referred to in these slides. http://www.youtube.com/watch?v=Zb_fVETGzwg
Some formatting is a little off in the translation to the current version of PowerPoint, but I didn't want to start editing and be tempted to change anything.

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February 2004 Hand Hygiene Presentation at Meeting of the Veterans Health Administration "Quality Management Integration Council"

  1. 1. Demystifying and Responding to CDC’s Hand Hygiene Guidelines and JCAHO’s related Patient Safety Goal for 2004 Presentation to QMIC, 2/4/04 Noel Eldridge, MS VHA National Center for Patient Safety 202 273-8878
  2. 2. Presentation Outline • CDC Guidelines and JCAHO Patient Safety Goals for 2004 • Summary of the Evidence • Letter from Dr. Roswell and Summary for VHA facilities • Six Sigma Project with 3M Corporation • Wrap-up
  3. 3. CDC Guidelines on Hand Hygiene • Issued October 25, 2002 • Issued by CDC and others: – “CDC Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force” • Since the CDC Guidelines were issued, new IOM and NQF studies also give preventing nosocomial infections high priority
  4. 4. Recommendations (44) from CDC Guidelines 1. Indications for handwashing and hand antisepsis (14) 2. Hand-hygiene technique (4) 3. Surgical hand antisepsis (5) 4. Selection of hand-hygiene agents (5) 5. Skin care (2) 6. Other Aspects of Hand Hygiene (6) 7. Health-care worker educational and motivational programs (3) 8. Administrative measures (5) Total Length: 1350 words in 45 page document
  5. 5. JCAHO Involvement • JCAHO issued 6 Patient Safety Goals for 2003 • JCAHO added a new one (#7) for 2004: – 7a: “Comply with current CDC hand-hygiene guidelines.” and – 7b: “Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-acquired infection.”
  6. 6. “Comply with current CDC hand-hygiene guidelines” Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. Category IB. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale. Category IC. Required for implementation, as mandated by federal or state regulation or standard. Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale. No recommendation. Unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exist.
  7. 7. JCAHO Patient Safety Goals • Resources: – December 2003 Topics in Patient Safety (TIPS) Newsletter: www.patientsafety.gov/tips.html – December 2002 TIPS Newsletter – JCAHO Website: www.jcaho.org/accredited+organizations/patient+safety/npsg.htm – VHA NCPS Website: INSERT INTRANET URL
  8. 8. The Evidence • 423 references in CDC Guidelines – From Laboratory Tests – From Hospitals – From Long-term Care Facilities – From Schools – On Bacteria, Viruses, Fungi – On Wild-type and Antibiotic-resistant Strains • From VAMCs
  9. 9. Study of Alcohol Handrub use at a Long-Term Care Facility • Compared the 2 units of the facility where alcohol hand-rubs were used with the rest of the facility. Key findings: – 30% fewer infections over a 34 month period • 2.27 (alcohol) vs. 3.19 (soap) per 1000 pt-days • Primary infections were urinary tract with Foley catheter, respiratory, and wound • 253,933 pt-days total; 81,036 in alcohol group – Reference: Fendler et al, AJIC, June 2002
  10. 10. Study of Alcohol Handrub use at an Acute Care Facility • Compared one unit (orthopedic surgery) of a hospital before and after introduction of alcohol handrubs in that unit. – 36% fewer infections (6 months before, 10 after). • 8.2 vs. 5.3 infections per 1,000 patient days • “Teachable” patients given 4 oz. alcohol gel too • Primary infections: urinary tract and surgical site • Cost savings studied: – Mean cost per infection: $4,828 +/- 4,868 – Cost of 10 months of supplies for unit: $1,688 – Reference: Hilburn et al, AJIC, April 2003
  11. 11. VHA Summary • Issued by Dr. Roswell in a memo to VISN Directors dated 12/15/03 • Also issued in December 2003 issue of TIPS Newsletter • Memo and web site contain cross-reference to CDC Guidelines
  12. 12. VHA Summary of JCAHO-required CDC Recommendations (19) I. All Health Care Workers with Direct Patient Contact (8) II. Surgical Hand Hygiene (3) III. Facility Management: Supplies (5) IV. Facility Management: Administrative Action (3) Total Length: 732 words (-45%)
  13. 13. Summary of VHA Summary (1) I. All Health Care Workers with Direct Patient Contact • Decontaminate hands before and after touching a patient (regular soap doesn’t do it) • Specific gloving recommendations • No artificial nails for HCWs contacting high risk patients • Soap and water for soiled hands
  14. 14. Summary of VHA Summary (2) II. Surgical Hand Hygiene • Guidance on surgical scrub with soap and water (e.g., shorter scrub times) • Guidance on surgical scrub with no-rinse alcohol- based products with ingredients for persistent action
  15. 15. Summary of VHA Summary (3) III. Facility Management: Supplies • Alcohol at room entrance and/or bedside • Alcohol available in pocket-sized dispensers • Alcohol in other convenient locations (e.g., in corridors is OK within limits) • Antimicrobial soap as an alternative to alcohol • Provide hand lotion to HCWs • Store alcohol safely -- it’s flammable
  16. 16. Summary of VHA Summary (4) IV. Facility Management: Administrative Action • Make HH a priority and provide financial and administrative support • Solicit input from employees • Monitor adherence and provide feedback on performance
  17. 17. Cross-reference
  18. 18. CDC Guidelines on Hand Hygiene • If you only remember one thing, remember this: Alcohol hand-rubs are better than soap and water. Why? 1. They kill germs better (lab data) and produce better outcome for patients (hospital data) 2. They are easier to use correctly (forcing function) 3. They are easier on hands (lab and hospital data) 4. People only use soap 20-50% of when they should (multiple hospital data)
  19. 19. Six Sigma Project with 3M Corporation • DMAIC – Define: project charter – Measure: process map, cause and effect matrix, – Analyze: failure modes and effects analysis, multi-variable studies – Improve: pilot studies – Control: control plan, hand-off training, final capability, owner sign-off, final project report
  20. 20. What we’re measuring (in 3 VAMC ICUs) • Staff compliance (observing staff with checklist and clipboard) • Volume of product used (to be converted to “doses” of alcohol handrub and soap) • Staff Attitudes and Perception of Compliance (questionnaire) • Antimicrobial soap in use (percent yes/no) • Staff artificial nails (percent yes/no) • Staff satisfaction with HH practice (questionnaire)
  21. 21. 3M-VHA Six Sigma Team Members Dr. Robert Bonello, Minneapolis VAMC Kay Clutter, Minneapolis VAMC Linda Danko, Infectious Diseases Dr. Edward Dunn, NCPS Noel Eldridge, NCPS Leann Ellingson, Minneapolis VAMC Mary Ann Harris, Fayetteville (AR), VAMC Barbara Livingston, Des Moines VAMC Renee Parlier, VISN 23 Cheryl Pederson, 3M Kim Reichling, 3M Dr. Gary Roselle, Infectious Diseases Susan Woods, 3M Dr. Steven Wright, OQP
  22. 22. Preliminary Data • Staff think they’re doing 90% when they’re doing 60% • Nurses and doctors are better than others (e.g., chaplains, technicians) • Number of HH opportunities doesn’t affect compliance • HCWs believe in connection between HH and infections, but are simultaneously skeptical about some specifics
  23. 23. Some Tentative Opportunities for Improvement • Improve availability of and access to appropriate supplies (make it easier to do it right) • Involving patients and visitors • Providing scientific evidence to educated skeptics (learning and unlearning) • Educating “others” of benefits of hand hygiene • HCWs reminding each other (culture change) • Feeding back real VAMC facility data on compliance/performance
  24. 24. What to do now • Get alcohol hand-rubs close to patients to make it convenient to use: in rooms or entrances to rooms, in hallways, and pocket size too. • Get antimicrobial soap in soap dispensers • Tell staff that the alcohol hand-rub should be primary method for hand decontamination • Don’t assume you know what the CDC Guidelines say, if you haven’t read them you don’t. It’s not always “common sense”. – Start with 1-page VHA summary
  25. 25. Final Thought • We know what doesn’t work: status quo of telling people to use soap and water and doing nothing when they don’t do it.
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