Hospital staff fostering innovation to increase hand hygiene rates

With awareness regarding hospital-based infection rates on the rise, it is now more important than ever for health-care workers to clean their hands at the right moments.

Southlake Regional Health Centre’s Infection Prevention and Control (IPAC) department recognizes that the threat of hospital-acquired infections has required an increased organizational focus on improving hand hygiene compliance.

As a result, ‘champions’ have been selected from each unit within the organization to support the hand hygiene initiative through monitoring and feedback. The champions serve as role models within their respective areas and have agreed to submit hand hygiene compliance reports to IPAC, while also providing friendly reminders to their colleagues to encourage them to clean their hands regularly. The reports document the department’s hand hygiene rates and identify opportunities for improvement.

As Brigette Boaretto, Southlake’s IPAC manager, expresses, “Champions act as change agents within their respective areas and consequently influence the hand hygiene behaviour of their peers. Not only do they monitor compliance, but they also support it by using creative cues and providing instant feedback.”

The champions are encouraged to create additional methods that support compliance in their areas and then share their success stories with other departments. There are a number of champions from different departments that have developed their own ways of reminding colleagues to clean their hands at the right times.

For example, Jill Moore, a champion and registered nurse in the Cardiovascular Intensive Care Unit (CVICU), has posted an image of a purple elephant next to every hand sanitizer in her department as a friendly and recognizable cue to urge staff members to clean their hands.

“The issue of hand hygiene is like the elephant in the room, nobody wants to talk about it,” said Moore. “Posting pictures of purple elephants serves as a fun and non-threatening way to remind staff to clean their hands.”

And while the purple elephant posters may not be appealing to everyone, they have still been successful, as indicated by a follow-up survey completed by the staff in the CVICU. The purple elephant posters are paired with posters that encourage patients to ‘share in their care’ by reminding health care providers to clean their hands, and corporate posters that read, “clean hands, clean conscience.”

According to Moore, who is also the Chair of the Unit Council and the Co-Chair of the Nursing Council, forgetfulness was one of the main reasons why people didn’t consistently clean their hands.

As staff forgetfulness calls for extra reminders, constant monitoring and feedback – in addition to the posters – works as an effective means to reinforce appropriate hand hygiene.

“Audits work as a method to offer feedback,” said Moore. “They provide education to those within that department, in addition to physicians and other health care providers who are caring for our patients.”

So while formal audits are performed, they are also paired with informal, friendly reminders that happen throughout the day to remind people to clean their hands.

These friendly verbal reminders are also part of a strategy implemented by other departments such as Medicine, whose leadership team has worked together to create a plan to increase hand hygiene compliance.

As part of this plan, the Medicine Management Team – including its Vice President – participated in scheduled compliance audits, during which real-time feedback was provided to staff.

Director of the Medicine Program and champion Jane Casey, indicates that, “We initially saw a decrease in our hand hygiene rates due to the increase in audits, but through providing real-time feedback, we are now seeing a significant improvement.”

In addition to completing multiple audits, the Department posts current hand hygiene data and the departmental target; this is completed by a daily chart to identify progress. If there are any issues that need to be addressed, the Department contacts IPAC to help resolve the issues.

Casey also supports hand hygiene compliance by increasing accessibility to the alcohol-based hand rub at the bedside, through providing a dispenser that hangs at the end of each bed in one of the medicine units.

While each department at Southlake has its own methods to enforce compliance, each champion-initiated method appears to be effective in serving its purpose of increasing hand hygiene rates.

“Each department is working hard to increase hand hygiene awareness,” said Boaretto. “While IPAC works to support unique departmental initiatives, each department is committed to communicating the importance of hand hygiene.”