March 2024 Healthcare Hygiene magazine March 2024 | Page 16

By Robert P . Lee

Recently , I visited a seriously ill , hospitalized friend and colleague . He and I have collaborated on numerous projects in our careers and both of us knew the dangers of spending too much time in a hospital bed . The hand hygiene observed during my 48-hour visit seems all too common and acceptable at many hospitals . The medical staff was very professional , and I admired their responsiveness , care and empathy .

In this discussion , I will focus on the staff hand hygiene and its execution I observed during my visit . Of note , this hospital has an A rating from the Leapfrog Group .

Environment :

● Hand hygiene gel dispensers were deployed outside each room

● A second hand-hygiene gel dispenser was deployed just inside the doorway

● Soap dispenser but no gel dispenser at the sink

● No gel dispenser in the bathroom

Observations :

● Could not validate that each healthcare worker sanitized upon entry

● Some healthcare personnel sanitized upon exit

• Nursing often did “ fly-bys ,” attempting to sanitize but not properly activating the dispenser

• Physicians were not observed sanitizing upon exit

● Healthcare workers often touched IV station , workstations , etc ., but no consequent hand hygiene prior to patient contact

● No hand hygiene prior to donning gloves or after gloves were removed

● Gloved healthcare personnel touched IV station , workstations , etc ., without changing gloves prior to touching the patient

● No healthcare personnel used soap / water at the sink

● No environmental services ( EVS ) visits to perform a room cleaning or a cleaning of high-touch surfaces

● Nursing did not perform a high-touch cleaning

● High-touch cleaning was performed by family and the patient advocate

● Advised by nursing staff that this unit was one of the highest performing regarding hand hygiene .

Clearly , my observations suggested issues with compliance as well as with education and training . It was my impression that the staff were not reluctant to perform hand hygiene , and even welcomed their recognition as a high performing unit . However , as noted above , there appeared to be significant gaps in the staff members ’ understanding of appropriate hand hygiene . What education and training could address the observed deficits ? Here are some suggestions :

1 . Establish and reinforce where and when hand hygiene is required during patient care : a . WHO 5 Moments ( entry / exit is inadequate ) b . Environmental contact prior to patient contact requires hand hygiene , even if hand hygiene occurred at room entry , and much like requirements in the operating room ( OR ), glove contamination requires re-gloving . c . Develop a planned workflow : If you touch parts of the environment before patient contact , realize that this will require repeat hand hygiene .

Clearly , education and training is critical , and the best way to learn is through observation , where errors become valuable teaching opportunities , whether in a simulation center ( if available ) or observation and training at the bedside .”

i . Am I going in to adjust the IV pumps ? ii . Am I going to log into the electronic health record ( HER )? iii . Am I going directly to the patient ? iv . Will I be gloving ?

2 . Establish a high-touch surfaces protcol : a . High-touch cleaning is require daily . b . Define who will perform this cleanse , the healthcare worker or EVS personnel

Training / Education / Certification

Clearly , education and training is critical , and the best way to learn is through observation , where errors become valuable teaching opportunities , whether in a simulation center ( if available ) or observation and training at the bedside . Requiring each staff member to demonstrate knowledge and competence in appropriate hand hygiene during patient care via a practicum each year and consequent certification would assure a well informed and competent staff regarding hand hygiene . Technology can provide significant assistance with observation real time , with electronic monitoring and / or videotaping patient encounters to provide feedback and education as noted above .

Additionally , I would hope that the Leapfrog Group would enhance their survey to include EVS and high-touch surface protocols , just as they enhanced their hand hygiene protocols and guidance over the years .

Exceptional hand hygiene does not just happen and requires investment to support training that results in the outcome we all strive for , reduction in healthcare-acquired infections ( HAIs ).

Robert Lee , BA , the CEO and founder of MD-Medical Data Quality & Safety Advisors , LLC , is the senior biologist and performance improvement consultant . MD-MDQSA is the home of The IPEX- The Infection Prevention Exchange , a digital collaboration between selected evidence-based solutions that use big data , technology , and AI to reduce risk of HAIs . Lee may be reached at : medicaldatamanagement @ gmail . com

16 • www . healthcarehygienemagazine . com • march 2024