The document outlines strategies for implementing a successful hand hygiene program in an emergency department. It begins by noting the low baseline hand hygiene compliance rate of 25% and describes various initiatives to improve rates, including increased availability of hand sanitizer, education of staff, and auditing practices. Regular auditing and feedback is emphasized as important to identify gaps and recognize positive behaviors. With a team-based approach and leadership support, the emergency department saw immediate uptake of new hand hygiene practices and a significant increase in compliance rates beyond initial goals.

1. IMPLEMENTING A HAND HYGIENE PROGRAM IN AN ED.
DIFFICULT... BUT NOT IMPOSSIBLE!
www.easternhealth.org.au
‘Glen’s Story was very good. I have converted to the rub’
‘My hand hygiene has definitely changed for the better’
‘After the Hand Hygiene program, it has changed my practice
and I have been using hand rubs’
‘Increased availability of handrub and education has been great’
‘Good having you around auditing as it provides a visual clue’
‘Increased use of ‘Pink Stuff’ at ends of the bed and at
shoulder height makes it a good visual cue’
‘I have noticed more patients and visitors using the hand rub’
‘My handrub use has increased +++’
‘Helpful to have specific examples to relate education to’
‘Topical, relevant, needed’
‘I liked having an Hand Hygiene auditor in the department as
it reminds me to be more aware of Hand Hygiene’
‘Regular reinforcement with ALL staff needed’
Feedback
August 2013
April 2013
December 2012
Teamwork
Recognize Champions
Local posters
Bottles of ABHR per month
used in the Emergency Dept
• Emergency Departments are the worst performing area’s across Australia at 69.1%
(Hand Hygiene Australia).
• Hand Hygiene is the most basic thing we do as a Health Care Worker, so why are we
so poor at it?
• What areYOU going to do about it?
Emergency Depts
B o x H i l l E m e rg e n c y D e p a r t m e n t
Jo-Anne McShane, Registered Nurse, Box Hill Hospital Emergency Dept, Melbourne Australia ~ joanne.mcshane@easternhealth.org.au ~ www.joannemcshane.weebly.com
“We have a Dirty Little Secret...
A spot Hand Hygiene audit showed a compliance rate of 25% based on theWHO: 5 Moments of Hand Hygiene.
This is what we did about it!”
• Even if you instil a good hand hygiene program in your
department, there will always be ongoing issues such as the
high turnover of staff, changes in portfolio management and
local buy in.
• If you do not have management support, your project is not
likely to succeed.
• Hand Hygiene can become boring and repetitive, so take
your time, try different methods, and most importantly
DON’T GIVE UP.
Challenges
for the future
Why do you need a
hand hygiene Project?
• Healthcare Associated Infections (HAI) means a increased length of stay = bed
blockage. Not good for ED’s!
• Poor Hand Hygiene compliance in the ED can cause infections in patients -
adverse outcomes are not seen usually seen by ED staff.
• Asepsis is the current flavour of the month- ED’s are known to be poor in
aseptic technique. Do you do Hand Hygiene before you put gloves on to insert
a cannula?
• Aligns with Accreditation – Standard 3.
• Standard precautions- HH according to the ‘5 moments of Hand Hygiene’. You
often don’t know if a pt is a carrier of a Resistant Organism such as MRSA,VRE
and C'Diff.
• How would you feel if your loved one developed a HAI through your ED?
• Our patients are getting clued onto Hand Hygiene- do it in front of them.
• It’s everybody’s business.We all need to look at our own practices. No excuses!
ABHR on bed ends
• Positive Feedback:
‘Great technique’
‘Good Hand Hygiene’
‘Mentos moments’ - give out a mentos and
explain the connection to a moment
• Recognise Excellence
• Feedback of Audit results at meetings
• Develop a Infection Control notice board
• Hand Hygiene and ‘glow germ’ In-services
• Promotion of being a good role model to
junior staff
• Talk about Hand Hygiene and Hand Care with your colleagues
• Introduce code words such as ‘Pink Stuff’ to remind staff to do
Hand Hygiene
• Increase ABHR around department and on end of bed ends
• Develop local posters
• Create Power Point slides to show in daily handover shift
meetings - keep to one page
• Glove box advertisement
• Use data to promote excellence within the district such as
in newsletters, quality and research meetings
• Emails providing link to the Hand Hygiene Australia website
Strategies
• Take ownership of your Hand Hygiene STATS and do something about it!
• Develop a team and make a plan (Project Plan).
• All key players should do the auditing workshop which can be accessed through
your Infection Control Department.
• Auditing is imperative to any Hand Hygiene Program - it allows you to identify
key area’s needed to change and get a ‘bigger picture’ of the problem.
• Auditing should be done monthly as this gives you the opportunity to feedback
results and give helpful hints.
• Ask your Infection Control Department to generate a report to feedback to the
ED. They can also help you strategize and market your project.
• A basic Hand Hygiene program can be done on a next to nothing budget with a
successful outcome.
• Online resources.- Hand Hygiene Australia website, Successfully Implementing
Change - www.health.vic.gov.au/.../successfully_implementing_change.pdf
document, and do a literature review on Hand Hygiene - there has been a lot of
publication on the topic.
Quick Guide: How to
International Hand Hygiene Day
World Health Organisation
5 Moments of
Hand Hygiene
All staff were required to complete the Hand
Hygiene Australia online learning package.
Reminder emails were sent to both nursing and
medical staff focusing of leadership and change
of culture.
• As with any project , change is dependent on the culture of the department,
therefore a team approach in imperative.
• This team should include the NUM, Medical Director of the Department,
at least one Doctor, several Nurses, Wardsmen, Administrative Clerks
and Allied Health.
Teamwork
• There was immediate uptake by the Nurse Unit Manager, Emergency Department
Medical Director, a Senior Consultant and the Education Team.
• Noticed a change in culture in the early months, people were talking about Hand
Hygiene and commenting on different situations that had occurred.
• Almost 100% of the department completed the HHA online learning package.
• Recognised Hand Hygiene Champions.
• A significant change in audit results way pass expectations and goals.
• Program coincided with Accreditation - Standard 3 (therefore easily justified).
Triumphs