The document discusses various challenges related to managing multidrug-resistant organisms (MDROs) such as VRE in healthcare settings. It notes an outbreak of VRE and lists actions requested of healthcare workers, but also acknowledges ongoing issues like hand hygiene compliance and misunderstandings around isolation protocols. While advanced infection control techniques are desirable, the document emphasizes that proper implementation of basics like hand hygiene, isolation, cleaning, and adherence to guidelines are most important. It raises questions around whether all MDROs require equal screening and management efforts. Regional coordination on surveillance, guidelines and personnel is presented as a strategy to improve practices across different care settings.
The document discusses various challenges with infection control in healthcare settings. It describes the spread of antibiotic-resistant pathogens through environmental contamination and between food animals, meat, and humans. Travel to certain regions is associated with higher rates of antibiotic-resistant infections. Proper cleaning, sterilization, use of protective equipment, and hand hygiene are important but not always consistently implemented by healthcare workers. New strategies may be needed to change behaviors and improve compliance with infection control guidelines.
The document discusses indicators for accrediting infection control units and hospitals. It proposes assessing structure, process, and outcomes, including monitoring incidence of multidrug-resistant organisms, adherence to infection control guidelines, and environmental cleaning. Outcome indicators like infection and colonization rates are prioritized. Risk stratification into categories like low, medium, and high is recommended based on national guidelines and expert opinion. Both resident and ward-level factors should be considered.
The document discusses strategies for improving antibiotic use and reducing healthcare-associated infections (HAIs) in hospitals. It recommends forming an improvement team to select and implement interventions, monitor compliance with interventions, and check outcomes. Specific interventions discussed include controlling use of reserve antibiotics, standardizing empiric treatment, promoting intravenous to oral switching, educating on antibiotic use, and requiring infectious disease consultation for certain high-risk patients. Real-time surveillance of local resistance trends and guidelines on antibiotic use and infection control are also recommended.
Presentation "Give up on VRE" as part of a debate at HIS 2014 (Lyon, France). Clearly not everything in here is my true opinion, but was part of "playing my part".
The document discusses several psychological models that are used to understand and predict behavior but are not widely applied in healthcare, including the Theory of Planned Behavior, Social Cognitive Theory, Operant Learning Theory, and others. It also examines how shortcuts in thinking, perceptual contrast, consistency principles, commitments, and opportunities for reciprocation can be leveraged to increase compliance. Specific techniques are provided like pre-committing individuals or asking for small initial favors to generate a sense of obligation to agree to larger requests.
The document discusses strategies for controlling methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. It describes the ideal "search and destroy" strategy of isolating and screening high-risk patients, decolonizing MRSA carriers, and taking consistent action when transmissions occur. However, it notes many healthcare facilities do not fully implement this strategy due to difficulties identifying at-risk patients and constraints like staffing issues. The document advocates for universal precautions like isolating MRSA-positive patients, promoting hand hygiene, and providing feedback to help facilities improve and reduce MRSA rates.
The document discusses various challenges related to managing multidrug-resistant organisms (MDROs) such as VRE in healthcare settings. It notes an outbreak of VRE and lists actions requested of healthcare workers, but also acknowledges ongoing issues like hand hygiene compliance and misunderstandings around isolation protocols. While advanced infection control techniques are desirable, the document emphasizes that proper implementation of basics like hand hygiene, isolation, cleaning, and adherence to guidelines are most important. It raises questions around whether all MDROs require equal screening and management efforts. Regional coordination on surveillance, guidelines and personnel is presented as a strategy to improve practices across different care settings.
The document discusses various challenges with infection control in healthcare settings. It describes the spread of antibiotic-resistant pathogens through environmental contamination and between food animals, meat, and humans. Travel to certain regions is associated with higher rates of antibiotic-resistant infections. Proper cleaning, sterilization, use of protective equipment, and hand hygiene are important but not always consistently implemented by healthcare workers. New strategies may be needed to change behaviors and improve compliance with infection control guidelines.
The document discusses indicators for accrediting infection control units and hospitals. It proposes assessing structure, process, and outcomes, including monitoring incidence of multidrug-resistant organisms, adherence to infection control guidelines, and environmental cleaning. Outcome indicators like infection and colonization rates are prioritized. Risk stratification into categories like low, medium, and high is recommended based on national guidelines and expert opinion. Both resident and ward-level factors should be considered.
The document discusses strategies for improving antibiotic use and reducing healthcare-associated infections (HAIs) in hospitals. It recommends forming an improvement team to select and implement interventions, monitor compliance with interventions, and check outcomes. Specific interventions discussed include controlling use of reserve antibiotics, standardizing empiric treatment, promoting intravenous to oral switching, educating on antibiotic use, and requiring infectious disease consultation for certain high-risk patients. Real-time surveillance of local resistance trends and guidelines on antibiotic use and infection control are also recommended.
Presentation "Give up on VRE" as part of a debate at HIS 2014 (Lyon, France). Clearly not everything in here is my true opinion, but was part of "playing my part".
The document discusses several psychological models that are used to understand and predict behavior but are not widely applied in healthcare, including the Theory of Planned Behavior, Social Cognitive Theory, Operant Learning Theory, and others. It also examines how shortcuts in thinking, perceptual contrast, consistency principles, commitments, and opportunities for reciprocation can be leveraged to increase compliance. Specific techniques are provided like pre-committing individuals or asking for small initial favors to generate a sense of obligation to agree to larger requests.
The document discusses strategies for controlling methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. It describes the ideal "search and destroy" strategy of isolating and screening high-risk patients, decolonizing MRSA carriers, and taking consistent action when transmissions occur. However, it notes many healthcare facilities do not fully implement this strategy due to difficulties identifying at-risk patients and constraints like staffing issues. The document advocates for universal precautions like isolating MRSA-positive patients, promoting hand hygiene, and providing feedback to help facilities improve and reduce MRSA rates.
This document discusses arguments for and against universal masking policies to prevent the spread of COVID-19. It notes that the definition of "universal masking" varies between countries and references studies on the effectiveness of masks. While masks may provide some protection, especially in healthcare settings, there is limited evidence on their effectiveness in community settings. Concerns about universal masking include improper use, a false sense of security, risk compensation, and lack of evidence that cloth masks work as well as medical masks. Overall, masks are presented as just one part of a comprehensive strategy, and not a replacement for other measures like distancing and isolating when sick.
The document discusses the risks posed by water sources in healthcare settings. It notes that water sources can be contaminated with pathogens like Legionella, nontuberculous mycobacteria (NTM), and fungi. Heater-cooler devices used in surgery have been linked to outbreaks of M. chimaera infections. Sinks and drains in patient rooms and bathrooms have been found to harbor multidrug-resistant bacteria and have caused outbreaks through aerosolization and contact with healthcare workers' hands. Removing sinks from intensive care unit rooms and implementing water-free patient care was associated with significantly lower gram-negative bacterial colonization rates in patients.
This document summarizes work done to implement antibiotic stewardship (AMS) programs in nursing homes in the Netherlands. It finds that while AMS is established in hospitals, it is unknown in nursing homes. It discusses adapting hospital AMS guidelines for nursing homes and the unique needs of nursing homes, including limited resources and staff training. It also reports on establishing an AMS team, monitoring antibiotic use data, providing education to nurses and families, and finding room for improvement, particularly around urinary tract infections. The overall inappropriate antibiotic use for UTIs in nursing homes was found to be 32%.
This document discusses patient involvement in infection prevention and control efforts. It suggests including patients in decisions about their own care, quality improvement projects, and strategic planning. Examples of how to engage patients include providing them with information via folders, posters and videos. The document also discusses patients' current internet use to research health topics and find support. It notes that while patients may become well-informed, they still need physician guidance. The rest of the document outlines strategies for engaging patients in hand hygiene monitoring and prevention of surgical site infections and UTIs.
1) The document discusses various methods for monitoring hand hygiene (HH) compliance, including direct observation and electronic monitoring systems (EMS).
2) EMS can continuously monitor HH at a larger scale than direct observers, but may not accurately assess the quality of HH episodes.
3) Several challenges exist with EMS including equipment costs, ensuring dispenser coverage in all needed areas, and potential interference with other devices. Proper implementation requires a team effort.
4) Studies show that while EMS can provide prompts to improve HH, rates may fall again without active intervention. Automated monitoring provides more accurate baseline data than human observers alone.
1) Hand hygiene is important for reducing infection rates in hospitals, which average between 8-12% but can be higher in critical care units at 15-40%.
2) Compliance with hand hygiene has increased with the introduction of alcohol-based hand rubs but barriers still exist including a lack of peer pressure and leadership support for hand hygiene practices.
3) There is debate around which specific moments should require hand hygiene and how many moments are realistically feasible for healthcare workers to comply with, though the WHO guidelines of 5 moments provide a clear framework.
This document discusses various preoperative, perioperative, and postoperative factors that can influence the risk of surgical site infections (SSIs). It identifies factors that are not influenceable, not probably influenceable, can be influenced by others, and can and should be influenced by healthcare providers. It emphasizes the importance of implementing basic practices first, such as appropriate hair removal methods, proper skin antisepsis, maintenance of normothermia, and use of antibiotic prophylaxis. Studies are referenced showing the impact of these factors, such as higher SSI rates with hypothermia during surgery. The document advocates a multifaceted approach focusing on modifiable factors to optimize SSI prevention.
This document discusses hand hygiene (HH) compliance among healthcare workers (HCWs) and different approaches to defining moments when HH should occur. It notes that past attempts to define many specific HH moments resulted in guidelines that were too complex to implement. The document advocates for a simpler approach using 5 core moments and acknowledges this still requires many HH actions per shift. It also explores social contact as a potential separate category and questions how to define such contact given microbes don't distinguish between care and social interactions. The document concludes that while the 5 moments approach may not be perfect, no better universally applicable and easy to remember alternative has been identified.
The document discusses a presentation on infection prevention and control given by Andreas Voss. It touches on several topics:
- Human factors engineering to help males aim better in restrooms to reduce spillage and cleaning needs.
- Studies showing priming behaviors like olfactory scents and images of eyes watching can influence honesty and cooperation.
- A study finding removing sinks from ICU rooms and implementing water-free patient care reduced gram-negative bacteria colonization rates in patients.
- The need for clear, unambiguous terminology to build understanding of antimicrobial resistance across different domains to facilitate a global response.
1. The document discusses challenges facing infection prevention and control (IPC) programs, including securing resources from hospital administrators who see IPC as a cost center rather than revenue generator.
2. It provides advice on how to advocate for IPC programs, including demonstrating the impact of healthcare-associated infections on costs and patient safety, using economic analyses to show potential cost savings, and leveraging crises to highlight the value of IPC.
3. The document emphasizes the importance of engaging hospital leadership in supporting a culture of patient safety and outlines a strategic vision for empowering IPC programs through appropriate structure, resources, and education.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
This document discusses antimicrobial stewardship programs and their impact on antimicrobial resistance and costs. It notes that while some studies have found reductions in antimicrobial use through stewardship programs can reduce costs, the relationship between use and resistance is complex. Randomized trials evaluating stewardship interventions found lower antimicrobial costs but similar patient outcomes compared to standard care. Overall the document examines both sides of the debate around whether antimicrobial stewardship reduces resistance or simply saves money.
This document summarizes strategies for improving physician compliance with hand hygiene recommendations. It begins by noting the typically low rates of compliance in Dutch hospitals and outlines factors that may contribute to non-compliance. These include perceptions that guidelines are too complex, that one's own situation is different, or simply not caring. The document then provides suggestions for addressing non-compliance, such as having repeated face-to-face conversations to emphasize evidence that non-compliance harms patients, limiting guidelines to one or two clear options to avoid decision paralysis, and appealing to peer pressure by emphasizing consistency with other institutions. The goal is to overcome barriers to compliance through effective communication and engagement strategies.
A "con" presentation of something I am really very much "pro". Still, this were the barriers I had to overcome why implementing S. aureus decolonization
This document summarizes an outbreak of vancomycin-resistant Enterococcus (VRE) at a hospital. It describes factors that contributed to the outbreak, including poor infection control practices like inadequate hand hygiene and contact isolation. Over 14 months and 450+ cases, efforts were made to control the outbreak through increased cleaning, screening cultures, audits, and feedback. However, challenges with staff fatigue, unit merging, and financial pressures made outbreak control difficult.
The document discusses the role of the hospital environment in the transmission of pathogens and healthcare-associated infections. It is estimated that 20% of pathogens causing infections in the intensive care unit come from the environment. Surfaces in patient rooms are often contaminated with pathogens, and contact with these surfaces can lead to healthcare worker contamination. Improved cleaning has been shown to reduce transmission of certain pathogens like C. difficile and VRE. The infectious dose may be very low for some environmental pathogens. The document examines various studies on the role of the environment in transmission and potential strategies to reduce environmental contamination.
The document discusses guidelines for infection control. It notes that guidelines are seen as both too restrictive by some and not restrictive enough by others. It emphasizes that guidelines need to be adapted to the local situation and highlights strategies for developing and implementing guidelines, including obtaining input from various stakeholders and ensuring guidelines are evidence-based. It also presents "The Ten Commandments of Infection Control" as a concise way to summarize key principles.
The document provides guidance on writing scientific papers, including identifying topics from clinical activities, past presentations, or unfinished projects. It recommends selecting a topic of personal interest and finding a mentor. The document outlines the typical sections of a paper and advises beginning writing even before research is complete. It stresses getting feedback early in the writing process and carefully editing for accuracy and style.
More Related Content
More from Radboudumc REshape Center for Innovation
This document discusses arguments for and against universal masking policies to prevent the spread of COVID-19. It notes that the definition of "universal masking" varies between countries and references studies on the effectiveness of masks. While masks may provide some protection, especially in healthcare settings, there is limited evidence on their effectiveness in community settings. Concerns about universal masking include improper use, a false sense of security, risk compensation, and lack of evidence that cloth masks work as well as medical masks. Overall, masks are presented as just one part of a comprehensive strategy, and not a replacement for other measures like distancing and isolating when sick.
The document discusses the risks posed by water sources in healthcare settings. It notes that water sources can be contaminated with pathogens like Legionella, nontuberculous mycobacteria (NTM), and fungi. Heater-cooler devices used in surgery have been linked to outbreaks of M. chimaera infections. Sinks and drains in patient rooms and bathrooms have been found to harbor multidrug-resistant bacteria and have caused outbreaks through aerosolization and contact with healthcare workers' hands. Removing sinks from intensive care unit rooms and implementing water-free patient care was associated with significantly lower gram-negative bacterial colonization rates in patients.
This document summarizes work done to implement antibiotic stewardship (AMS) programs in nursing homes in the Netherlands. It finds that while AMS is established in hospitals, it is unknown in nursing homes. It discusses adapting hospital AMS guidelines for nursing homes and the unique needs of nursing homes, including limited resources and staff training. It also reports on establishing an AMS team, monitoring antibiotic use data, providing education to nurses and families, and finding room for improvement, particularly around urinary tract infections. The overall inappropriate antibiotic use for UTIs in nursing homes was found to be 32%.
This document discusses patient involvement in infection prevention and control efforts. It suggests including patients in decisions about their own care, quality improvement projects, and strategic planning. Examples of how to engage patients include providing them with information via folders, posters and videos. The document also discusses patients' current internet use to research health topics and find support. It notes that while patients may become well-informed, they still need physician guidance. The rest of the document outlines strategies for engaging patients in hand hygiene monitoring and prevention of surgical site infections and UTIs.
1) The document discusses various methods for monitoring hand hygiene (HH) compliance, including direct observation and electronic monitoring systems (EMS).
2) EMS can continuously monitor HH at a larger scale than direct observers, but may not accurately assess the quality of HH episodes.
3) Several challenges exist with EMS including equipment costs, ensuring dispenser coverage in all needed areas, and potential interference with other devices. Proper implementation requires a team effort.
4) Studies show that while EMS can provide prompts to improve HH, rates may fall again without active intervention. Automated monitoring provides more accurate baseline data than human observers alone.
1) Hand hygiene is important for reducing infection rates in hospitals, which average between 8-12% but can be higher in critical care units at 15-40%.
2) Compliance with hand hygiene has increased with the introduction of alcohol-based hand rubs but barriers still exist including a lack of peer pressure and leadership support for hand hygiene practices.
3) There is debate around which specific moments should require hand hygiene and how many moments are realistically feasible for healthcare workers to comply with, though the WHO guidelines of 5 moments provide a clear framework.
This document discusses various preoperative, perioperative, and postoperative factors that can influence the risk of surgical site infections (SSIs). It identifies factors that are not influenceable, not probably influenceable, can be influenced by others, and can and should be influenced by healthcare providers. It emphasizes the importance of implementing basic practices first, such as appropriate hair removal methods, proper skin antisepsis, maintenance of normothermia, and use of antibiotic prophylaxis. Studies are referenced showing the impact of these factors, such as higher SSI rates with hypothermia during surgery. The document advocates a multifaceted approach focusing on modifiable factors to optimize SSI prevention.
This document discusses hand hygiene (HH) compliance among healthcare workers (HCWs) and different approaches to defining moments when HH should occur. It notes that past attempts to define many specific HH moments resulted in guidelines that were too complex to implement. The document advocates for a simpler approach using 5 core moments and acknowledges this still requires many HH actions per shift. It also explores social contact as a potential separate category and questions how to define such contact given microbes don't distinguish between care and social interactions. The document concludes that while the 5 moments approach may not be perfect, no better universally applicable and easy to remember alternative has been identified.
The document discusses a presentation on infection prevention and control given by Andreas Voss. It touches on several topics:
- Human factors engineering to help males aim better in restrooms to reduce spillage and cleaning needs.
- Studies showing priming behaviors like olfactory scents and images of eyes watching can influence honesty and cooperation.
- A study finding removing sinks from ICU rooms and implementing water-free patient care reduced gram-negative bacteria colonization rates in patients.
- The need for clear, unambiguous terminology to build understanding of antimicrobial resistance across different domains to facilitate a global response.
1. The document discusses challenges facing infection prevention and control (IPC) programs, including securing resources from hospital administrators who see IPC as a cost center rather than revenue generator.
2. It provides advice on how to advocate for IPC programs, including demonstrating the impact of healthcare-associated infections on costs and patient safety, using economic analyses to show potential cost savings, and leveraging crises to highlight the value of IPC.
3. The document emphasizes the importance of engaging hospital leadership in supporting a culture of patient safety and outlines a strategic vision for empowering IPC programs through appropriate structure, resources, and education.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
This document discusses antimicrobial stewardship programs and their impact on antimicrobial resistance and costs. It notes that while some studies have found reductions in antimicrobial use through stewardship programs can reduce costs, the relationship between use and resistance is complex. Randomized trials evaluating stewardship interventions found lower antimicrobial costs but similar patient outcomes compared to standard care. Overall the document examines both sides of the debate around whether antimicrobial stewardship reduces resistance or simply saves money.
This document summarizes strategies for improving physician compliance with hand hygiene recommendations. It begins by noting the typically low rates of compliance in Dutch hospitals and outlines factors that may contribute to non-compliance. These include perceptions that guidelines are too complex, that one's own situation is different, or simply not caring. The document then provides suggestions for addressing non-compliance, such as having repeated face-to-face conversations to emphasize evidence that non-compliance harms patients, limiting guidelines to one or two clear options to avoid decision paralysis, and appealing to peer pressure by emphasizing consistency with other institutions. The goal is to overcome barriers to compliance through effective communication and engagement strategies.
A "con" presentation of something I am really very much "pro". Still, this were the barriers I had to overcome why implementing S. aureus decolonization
This document summarizes an outbreak of vancomycin-resistant Enterococcus (VRE) at a hospital. It describes factors that contributed to the outbreak, including poor infection control practices like inadequate hand hygiene and contact isolation. Over 14 months and 450+ cases, efforts were made to control the outbreak through increased cleaning, screening cultures, audits, and feedback. However, challenges with staff fatigue, unit merging, and financial pressures made outbreak control difficult.
The document discusses the role of the hospital environment in the transmission of pathogens and healthcare-associated infections. It is estimated that 20% of pathogens causing infections in the intensive care unit come from the environment. Surfaces in patient rooms are often contaminated with pathogens, and contact with these surfaces can lead to healthcare worker contamination. Improved cleaning has been shown to reduce transmission of certain pathogens like C. difficile and VRE. The infectious dose may be very low for some environmental pathogens. The document examines various studies on the role of the environment in transmission and potential strategies to reduce environmental contamination.
The document discusses guidelines for infection control. It notes that guidelines are seen as both too restrictive by some and not restrictive enough by others. It emphasizes that guidelines need to be adapted to the local situation and highlights strategies for developing and implementing guidelines, including obtaining input from various stakeholders and ensuring guidelines are evidence-based. It also presents "The Ten Commandments of Infection Control" as a concise way to summarize key principles.
The document provides guidance on writing scientific papers, including identifying topics from clinical activities, past presentations, or unfinished projects. It recommends selecting a topic of personal interest and finding a mentor. The document outlines the typical sections of a paper and advises beginning writing even before research is complete. It stresses getting feedback early in the writing process and carefully editing for accuracy and style.
More from Radboudumc REshape Center for Innovation (20)
1. 25-‐04-‐12
Andere beroepen…
Compliance check Low price & safety possible
Als zij niet luisteren … De vraag is ….
• Zou
u
met
deze
mensen
mee
vliegen
(u
leven
in
hun
handen
geven)?
1
2. 25-‐04-‐12
One major difference between a surgeon
and a pilot if things go wrong … We ask HCWs to keep the speed limit
…
the
pilot
will
be
among
the
dead
… de realiteit in Nederland!
InfecBon
control
a
Gevaarlijk micro-organisme: MRMS MRZA
• Resistent
voor
goede
raad
MulB-‐Resistant
Medische
• Allergisch
tegen
professionele
richtlijnen
Specialist
• Non-‐compliant
met
infecBe
prevenBe
• Blind
voor
zorg-‐gerelateerde
infecBes
• Andere
prioriteiten
2
3. 25-‐04-‐12
HH compliance in Nederland
Why
aren’t
the
HCWs
doing
what
we
ask
them
to
do?
If hospital bugs would look like this – compliance
Waarom is dat zo? with hand hygiene would be 100%
…
we
don’t
see
that
we
put
a
paBent
at
risk!
3
4. 25-‐04-‐12
Perceived barriers of hand hygiene Observed barriers for non-compliance
• Handwashing
agents
cause
irritaBon
&
dryness
• To
be
a
physician
• OVen
too
busy
/
insufficient
Bme
• To
be
a
nursing
assistant
• PaBent
needs
take
priority
• Male
gender
• Low
risk
of
acquiring
infecBons
from
paBents
• Working
in
an
ICU
• Sinks
are
inconveniently
located
• Working
during
the
week
(vs.
week-‐end)
• Wearing
of
gloves
• Wearing
gowns
/
gloves
• Lack
of
knowledge
of
guidelines
/
protocols
• Automated
sink
• Not
thinking
about
it
/
forgeulness
• AcBviBes
with
high
risk
of
cross-‐transmission
• High
acBvity
index
(high
no.
opp./hour)
Larson and Killien , AJIC 1982;10:93 Dubbert et al., ICHE 1990;11:191 Zimakoff et al. AJIC 1992;20:58
Conly et al. AJIC 1989;17:330 Sproat and Inglis, JHI 1994; 26:137 Larson and Kretzer, JHI 1995;30:88
Pittet et al. Annals Intern Med 1999; 130:126 Kretzer and Larson, AJIC 1998;26:245 Piaet
et
al.
Annals
Intern
Med
1999;
130:126
Kretzer
and
Larson,
ACIC
1998;26:245
De dynamiek van gedragsverandering Motivatie
Probleem
Oplossing
Gecombineerd
«
Ik
niet
»
Gecombineerd
oplossing
• Ik
weet
niet
hoe
…
Training
• Ik
heb
niet
de
middelen
Systeem
verandering
• Ik
doe
het
niet
MoBvaBe
Ik ben niet lui, het interesseert mij gewoon niet.
Disinfect your
hands
you murderer!
>150
years
of
blame
were
not
Semmelweis
“schlepping”
his
colleagues
to
disinfect
their
hands
really
successful
4
5. 25-‐04-‐12
Hoe kunnen wij medewerkers Gimme an Rx!
beinvloeden? Cheerleaders Pep Up Drug Sales
Onya,
the
Redskins
cheerer
• Het
presenteren
van
iets
“nieuw”
of
(who
asked
that
her
last
name
be
withheld,
ciBng
team
policy),
“verbeterd”
leidt
niet
automaBsch
tot
has
her
picture
on
the
team's
verandering
van
het
gedrag
Web
site
in
her
official
bikini-‐
like
uniform
and
also
reclining
• ‘Wat
wij
kunnen
leren
van
markeBng
in
an
actual
bikini.
Onya,
27,
who
declined
to
idenBfy
the
professionals?
company
she
works
for,
is
but
one
of
several
drug
Mensen
zijn
veel
meer
willens
om
te
representa5ves
who
have
veranderen
als
zij
zich
goed,
gevleid,
machBg
cheered
for
the
Redskins
of
sexy
voelen,
dan
op
het
moment
dat
we
ze
overvloeden
met
feiten(Hodgkin
1999)
… team deskundige infectiepreventie Zelfbescherming = goede motivatie?
MRSA: import versus verworven Humor als motivatie
first
MRSA
isolate
was
recovered
within
72
h
of
ICU
admission
P
<
0.01
first
MRSA
isolated
aVer
72
h
of
ICU
admission
Stop met
de onzin
en neem
jou bad.
als peuter.
SARS
Pre-‐SARS
Post-‐SARS
Clin
Infect
Dis
2004;39:511-‐516
5
6. 25-‐04-‐12
Humor als motivatie Dwang als motivatie ?
• ImplementaBe
van
handen
hygiëne
als
“moet”
voor
de
instelling
• Frequente
observaBes
and
rapportage
van
non-‐compliant
medewerkers
• Waarschuwing
(eerste)
door
afdelingshoofd
• Straf
(korBng
op
salaris,
ontslag)
Instelling
heeV
binnen
een
jaar
100%
compliance
berijkt,
Maar
is
dit
de
manier
om
het
te
doen?
SHEA
Chicago
2005
Patiënten medewerking Schoon handen
• Bevorder
een
cultuur
van
veiligheid
en
zonder
schuld-‐
toewijzing,
zorg
voor
verbetering
in
plaats
van
fouten
verwijten
• balans
tussen
systeem
fouten
(te
veel
werk,
ontbreken
training,
verstrekking
van
middelen)
en
verantwoord-‐
elijkheid
van
individu's
(niet
opvolgen
van
duidelijke
en
haalbaar
richtlijn
=
grof
fout)
• Grof
fout
in
de
industrie
(KLM,
NXP)
versus
gezondheidszorg
PaBënten
medewerking:
…
zijn
kunnen
(en
zouden)
niet
verantwoordelijk
zijn
voor
hun
eigen
veiligheid
in
een
omgeving
waarover
zij
geen
controle
hebben
Maak medewerker verantwoordelijk en afrekenbaar
George Annas NEJM 354;19:2063-2066 Goldman
NEJM
2006;355:121-‐122
De invloed van weerstand op de
InfecBon
control
preventie en het ontstaan van HAI
-‐
how
can
we
make
it
sBck
?
• Sinds
october
2008,
betaald
de
verzekeraar
bij
bepaalde
HAI
het
ziekenhuis
niet
meer
–
dus
geeV
het
ziekenhuis
meer
aandacht
aan
prevenBe.
• Studie:
wat
zijn
de
barrieres
(i.h.b.
bij
het
personeel)
om
effecBeve
infecBeprevenBe
maatregelen
niet
in
zorg-‐instellingen
te
implemenBeren
Saint
S
et
al.
Jt
Comm
J
Qual
PaBent
Saf
2009;35:239
6
7. 25-‐04-‐12
De invloed van weerstand op de
preventie en het ontstaan van HAI
Vertaal onderzoek in praktijk
• Goed
manier
om
acBeve
weerstand
te
doorbreken:
• Het
feit
dat
er
bewijs
is
– benchmarking
HAI
raten
voor
effecBef
– vinden
van
“champions”
(sleutelpersonen)
infecBeprevenBe
matregelen
heet
niet
– Deelname
aan
een
organisaBe-‐breed
doel.
dat
ze
ook
alBjd
• Herken
en
reageer
op
tegenliggers
door:
omgezet
kunnen
– Betrek
de
tegenliggers
vanaf
het
begin
bij
iedere
worden
in
de
prakBjk.
discussie
– Gewoon
doorgaan
om
de
de
persoon
heen
– Ontsla
de
tegenligger.
Saint
S
et
al.
Jt
Comm
J
Qual
PaBent
Saf
2009;35:239
Saint
S
et
al.
Jt
Comm
J
Qual
PaBent
Saf
2009;35:239
Improving infection control practices Keep others view in mind ..
• Because
of
the
complexity
of
the
process
of
change,
it
is
not
surprising
that
single
intervenBon
oVen
fail
…
• …
a
mulBmodal
approach
is
necessary
Change our knowledge & skills … Listen to your doctor …
You
need
to
learn
more
about
behavioral
science!
Goed
voorbeeld
7
8. 25-‐04-‐12
Offer education …
Be consequent ! Only implement needed rules
Monitoring Encourage HCWs to think despite guidelines
Single
control
ConBnious
control
8
9. 25-‐04-‐12
… avoid that our best intentions and methods have a
Try to find out what your customer wants! completely reversed effect
² Many
Bmes
we
offer
our
help
assuming
that
we
know
what
HCWs
need
and
how
we
can
help
them
…
whereas
our
assumpBons
and
reality
frequently
differ
!
More than just HCWs … Clinicians & IC – building bridges
HCWs
Management
IC-‐team
• Herken
noodzaak
• Nieuwe
kennis
Just
don’t
Just
ignore
Are
not
InfecBe
PrevenBe
• Pro-‐acBever
do
it
it
pro-‐acBve
Hand in eigen boezem …
9