How to conduct hand hygiene observations


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Purpose of the call:
•Review process of conducting Hand Hygiene observations
•Preparation for the Canadian Hand Hygiene Audit Event

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How to conduct hand hygiene observations

  1. 1. Canadian Hand Hygiene Audit Event Mar 26, 2014
  2. 2. Welcome from the team Bienvenue, de la part de l’équipe Gina PeckAnne MacLaurin Virginia Flintoft Alexandru Titeu Hélène Riverin Dr. Michael Gardam Leah Gitterman
  3. 3. Where are you joining from? Use your pointer Où êtes-vous joindrez à partir? Utilisez votre pointeur
  4. 4. Discuss the details of the Canadian Hand Hygiene Audit Event Review process of conducting Hand Hygiene observations Data collection tips for the Canadian Hand Hygiene Audit Event Purpose of today’s call
  5. 5. Canadian Hand Hygiene Audit When? – April 2014 Purpose: – Create awareness around appropriate Hand Hygiene practice – Obtain an estimate of national Hand Hygiene rates – Promote the new Data Collection Tool and to support good Hand Hygiene
  6. 6. Canadian Hand Hygiene Audit Your commitment: – 50 moments per unit – Secure executive sponsor support and resources as required.
  7. 7. Who is included? The Canadian Hand Hygiene audit will focus on: – Acute Care – Long-term Care – Home Care Audit sample can be: – Entire organization – Specific units or programs
  8. 8. Hand Hygiene Observation and Analysis Michael GardamLeah Gitterman
  9. 9. HAND HYGIENE OBSERVATION AND ANALYSIS Leah Gitterman University Health Network Infection Prevention and Control
  10. 10. Direct observation Use the 4 moments Conduct observations openly without interfering with ongoing work Anonymous observation Feedback the data to the front line staff How to observe hand hygiene
  11. 11. Moment: refers to the 4 times it is essential that HCW’s clean their hands Opportunity: need to perform hand hygiene Terminology Zimmerman et. al. Healthcare Papers 2013
  12. 12. How will you identify types of healthcare workers? Introduce yourself to the unit Learn the workflow of the area you are auditing Be open to answering questions from staff and patients Preparing to Audit
  13. 13. Suggested to observe up to 3 HCW’s at a time Each observation session takes on average 20 minutes (can be some variability here) Try to audit at different times/shifts Preparing to audit
  14. 14. How to use the form • Each column is for recording hand hygiene opportunities of one health care provider only. Use additional columns for each additional health care provider being observed Note: The Long-Term Care Observation Tool uses “Category” instead of HCP. • As soon as you observe the first indication for hand hygiene, indicate the corresponding information in the first of the numbered opportunity sections in the column corresponding to the health care provider being observed.
  15. 15. Before initial patient/environment contact (BEF-PAT/ENV) • if the health care provider touches the patient’s environment and then touches the patient or • goes directly to touch the patient after having touched the hospital environment (= any other surface not in the patient’s environment) or another patient’s environment • if the health care provider enters the patient’s environment and touches only the patient’s environment (does not touch patient) and then leaves the patient’s environment.
  16. 16. Before Aseptic Procedure (BEF-ASP) • Wound care, dressing change, wound assessment • Manipulate an invasive device (e.g., priming intravenous infusion set, inserting spike into opening of IV bag, flushing line, adjusting intravenous site, administering medication through IV port, changing IV tubing).
  17. 17. After body fluid exposure (AFT-BFL) After contact with blood or blood products, emptying urinal/catheter bag and suctioning oral/nasal secretions
  18. 18. After patient/patient environment (AFT- PAT/ENV) • health care provider leaves the patient and his/her environment to go on working in the hospital environment or with another patient • health care provider leaves the patient area after touching objects in the patient environment (without touching the patient) to go on working in the hospital environment or with another patient.
  19. 19. Ensure that staff know what you are auditing Be open and honest about the process Be clear from the beginning if you will be using ‘on the spot’ feedback Share the data regularly Be consistent! Tips
  20. 20. E.g. HCW enters a room, cleans hands with alcohol and then immediately performs an aseptic procedure. This counts as BEF- PAT/ENV and BEF-ASP Document whether alcohol or soap and water was used. Mark down all opportunities and type of HH action performed
  21. 21. Indicate if gloves were worn and if HH performed appropriately before and after Refer to your facility's policy on rings, bracelets and nails If auditing is new, consider not focusing on the timing of duration of HH. Add this in once the overall process for auditing is running smoothly Gloves, nails, bracelets, rings, timing
  22. 22. The nurse opens the door, uses alcohol hand gel enters the room and goes towards the patient and introduces herself The nurse moves the bedside table The nurse helps the patient to bring out his arm from under the sheets Scenario 1
  23. 23. Key messages: • The nurse performs hand hygiene while approaching the patient environment. • The nurse handrubs before touching surfaces and objects. As these are part of patient’s environment, it is not necessary to perform hand hygiene again before touching the patient. • The indication remains “before initial patient/patient environment contact.” Scenario 1
  24. 24. •The nurse uses alcohol based hand rub in the corridor •The nurse is on his way to the room and suddenly remembers he needs to make a phone call. The nurse uses the phone in the waiting area (last contact with health care environment) and then goes directly into the room towards the patient •The nurse helps the patient to bring his arm out from under the sheets Scenario 2
  25. 25. Key messages: After performing hand hygiene in the corridor (additional action not corresponding to any recommended indication), the nurse then touches the phone in the waiting area and thus potentially contaminates his hand. The nurse then misses the action before initial patient/patient environment contact, potentially contaminating him with those germs Scenario 2
  26. 26. • The nurse enters the room, performs HH and places the equipment ready for giving an IV medication on the overbed table • IMED pump alarms so nurse resets pump • The nurse moves the overbed table and performs HH • The nurse cleans the IV port and injects the medication into the IV port (aseptic procedure) Scenario 3
  27. 27. • Key Messages: The nurse has a first direct contact with the patient (performs hand hygiene as indicated) and the patient environment; she then repeats the hand hygiene action before the aseptic procedure to protect the patient from her own organisms. Scenario 3
  28. 28. • The gloved nurse in the room punctures the patient’s finger and squeezes drops of blood onto a strip and then tests with the glucometer • When the nurse finishes, she places the lancet in the sharps container and then places the alcohol swab in the garbage. She then takes off her gloves and places them into the garbage • The nurse takes the patient's pulse Scenario 4
  29. 29. • Key messages: Hand hygiene must be performed immediately after body fluid exposure risk, before touching either the patient again or any surface and object within the patient environment or health care environment, to prevent potential dissemination of organisms. Any care activity implying contact with body fluids constitutes a risk because exposure may not be visible but may have happened. Scenario 4
  30. 30. How to participate? Alexandru Titeu Central Measurement Team
  31. 31. Patient Safety Metrics - Introduction Getting Data In – Data Collection Forms (DCF) – Patient-level – Worksheets - Numerator and Denominator – Hand Hygiene Audit – Acute, LTC, Home Care – Requirements for Faxing Patient Safety Metrics - Demo – How to enroll in Hand Hygiene Intervention for all sectors – How to add and generate the forms – How to view data and run reports Agenda
  32. 32. Features: Cloud-based data collection and reporting tool – no cost to user Accessible by registered members (email and password) Available in English and French Tracks >100 process and outcome measures over 14 interventions Provides real time reporting and export of data to CSV/Excel Roll Up or Drill Down Reports (i.e. Unit Organization Health Region Province National) with automated Run Charts Patient Safety Metrics
  33. 33. Getting Data In Data Collection (Audit) Forms
  34. 34. Data Collection (Audit) Forms - DCF – Patient-level data (de-identified) - daily – Multiple data elements – Print form Collect data Fax form – Automatic roll-up to Measurement Worksheets Data Collection Forms
  35. 35. Hand Hygiene Audit Tool so we may contact you in the event of an error
  36. 36. Hand Hygiene Audit Tool Long-Term Care and Home Care Acute Care + Family caregiver
  37. 37. Hand Hygiene Audit Tool Acute Care
  38. 38. Hand Hygiene Audit Tool Once per  HCP
  39. 39. Patient-Family HH Data Collection Form 41 Are you collecting HH observations from the Pt-Family Perspective? Are you collecting HH observations in Home Care? Tell us how in the ‘chat’ box…
  40. 40. Enter your Name, Phone Number, and E-mail in the top-left corner (so we may contact you in the event of an error) Enter all elements of the Date (year, month, day) on all forms Enter Day as a double digit (e.g. the 3rd should be entered as 03, with 0 on the top row and 3 on the row below) Requirements for faxing DCFs
  41. 41. Fax in batches that are 10 pages or less Fax with NO COVER PAGE Set fax machine to FINE or SUPERFINE RESOLUTION Use a Flatbed (flat glass scanning) fax machine if possible Login to PSMetrics one hour after faxing your forms to verify the data was received successfully Requirements for faxing DCFs
  42. 42. Do not hole punch, fold or spill anything on the form Do not cross out bubbles if you made a mistake, use the VOID bubble to exclude wrong sections Fill in bubble completely (Sharpie is best, pen and pencil are OK) - do not stack forms because ink may bleed through the paper Do not write or make extra markings on the form Beware of common mistakes!
  43. 43. Getting Data In Measurement Worksheet
  44. 44. Measurement Worksheets – Aggregate data - monthly – Numerator and Denominator – Created automatically when you add your DCFs Measurement Worksheets
  45. 45. Accessing Measurement Worksheet
  46. 46. Accessing Measurement Worksheet
  47. 47. Accessing Measurement Worksheet
  48. 48. Entering Data on Msmnt Worksheet
  49. 49. Entering Data on Msmnt Worksheet
  50. 50. Patient Safety Metrics - Live Demo 54 Patient Safety Metrics Central Measurement Team Virginia Flintoft & Alexandru Titeu
  51. 51. STOP! Clean Your Hands Day Journée ARRÊT! Nettoyez-vous les mains Register now! / Inscrivez-vous maintenant!
  52. 52. Upcoming calls / Appels à venir STOP! Clean Your Hands Day: Brief summary of Hand Hygiene Audit Results followed by ‘What’s Your Hand In It’: Pitch to the ‘Dragons’ May 5th, 2014 Time: 9:00 -10:30 a.m. PDT /10:00 -11:30 a.m. MDT /11:00 a.m. – 12:30 p.m. CDT /12:00 -1:30 p.m. EDT /1:00 -2:30 p.m. ADT /1:30 -3:00 p.m. NDT Presentation of Findings from the Canadian Hand Hygiene Audit Event May 20th, 2014 Time: 9:00 -10:00 a.m. PDT /10:00 -11:00 a.m. MDT /11:00 a.m. – 12:00 p.m. CDT /12:00 -1:00 p.m. EDT /1:00 -2:00 p.m. ADT /1:30 -2:30 p.m. NDT Series of Hand Hygiene Improvement Calls : Date, Time and Topic TBD
  53. 53. Questions?
  54. 54. Thank You / Merci Evaluation Poll Sondage d’évaluation