Please join us at 12 EST November 7th as we learn more about Infection Prevention and Control in the Home Care and Long Term Care practice environments. Dr. Michael Gardam, our Safer Healthcare Now! IPAC faculty lead will: •Discuss infection control strategies in the home care and long term care sectors, with a special emphasis on hand hygiene •Explain why more traditional quality improvement strategies may not work for hand hygiene, and •Illustrate how front-line ownership can be used to bring about practice improvements.​ Click to watch the webinar recording: http://bit.ly/1yDu6c5

1. FRONT LINE OWNERSHIP TO IMPROVE SAFETY IN LONG TERM CARE AND HOME CARE
Michael Gardam
Leah Gitterman

2. 
Link to slides for today’s call
will be posted in the chat box

Call will be taped

Certificate of attendance
Before We Get Started

4. Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliser
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Be prepared to use: - Raise hand - CHAT
Have you used WebEx before? Avez-vous déjà utilisé WebEx?
Soyez prêts à utiliser les outils :
- lever la main
- clavardage
Type your message & click ‘send’
Select ‘send to’

5. Lots of work has been done with hand hygiene in acute care but what about long term care and home care?

6. Available Tools

Staff hand hygiene

Patient/client hand hygiene

Environmental cleaning

cleaning multiuse equipment

Vaccination

Staff sick policies

Visitor sick policies

Aseptic technique

catheter avoidance

antimicrobial stewardship

Ventilation

Surveillance

Isolation

7. Acute care ≠Long term/home care
ICU

multiple IV lines

Acute physical stress
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Frequent recent wounds/broken skin barriers
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Frequently ventilated
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Frequent infections, multiple antibiotic exposures
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Surrounded by very sick people
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Constantly touched by healthcare workers
Long term/home care
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rarely any IV lines
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Chronic physical ailments
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May have broken skin barriers
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Almost never ventilated
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Rarely infected, much less frequent antibiotics
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Much less and different physical contact

8. Hand Hygiene
Moment
Acute, CCC, LTC
Home Care
Before contact with patient or their environment
beds, chairs, patients, clients, etc
Between home visits
Before performing aseptic procedure
as it says!
Ditto
After contact with body fluids
as it says!
Ditto
After contact with patient or their environment
beds, chairs, patients, clients, etc
Between home visits

9. Some examples from WHO guidance document

10. Same principles
as acute care

14. culture eats strategy for breakfast

15. How we think the healthcare world works:
A B
How most of it really works:
W B
BLACK BOX

16. Simple
Complicated
Complex
Types of Problems
Adapted from Brenda Zimmerman

17. Simple problems

One size fits all

Search for standardization

Problem solving

Checklists

Best Practices

19. Complex problems

Social Immune response

One size never fits all

Multiple actions (no “one big fix”)

Paradoxes exist

Social Proof matters

Relationships matter

20. This won’t work

21. Minimum Specifications (simple rules)

23. An approach to complex problems: Positive Deviance
Increasing performance

24. Positive Deviance in action 24

25. RONT
INE
WNERSHIP
Zimmerman et. al. Healthcare Papers, 2013

26. Improving safety in a complex world
Prevention
Resilience

27. How to get here?
From here?

28. Principles of This Work

Work with willing participants

change spreads in infinite ways

Make the invisible visible

Include the unusual suspects

Go slow to go fast

Nothing about me without me

Act your way into a new way of thinking

Things may get worse before they get better

29. This work is about the HOW rather than the WHAT

30. Available Infection Control Tools

Staff hand hygiene

Patient/client hand hygiene

Environmental cleaning

cleaning multiuse equipment

Vaccination

Staff sick policies

Visitor sick policies

Aseptic technique

catheter avoidance

antimicrobial stewardship

Ventilation

Surveillance

Isolation

31. 31
The Hand Hygiene Hurdles

35. Fall Prevention Ideas…
different socks
fall monitors
Bedside report
talking to patients
stay with patients while in the bathroom
“busy” aprons
change blood draw time

36. 0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Q1 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Falls per 1000 patient days
Total Falls Rate, ACTIVE BOZ Units
BOZ Total Rate
Linear (BOZ Total Rate)
Linear (Baseline)

37. Culture SHIFT

Taking time to think

Practice-based evidence (social proof)

Stories and relationships are trusted

Culture change is simple

Leaders need to step back

Bottom up leadership from the front-line

38. “Insanity: doing the same things over and over again and expecting different results.”
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39. igniteconsulting.net leah.gitterman@uhn.ca michael.gardam@uhn.ca @DrMichaelGardam

40. Instructions to download certificate
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