By Lindsay Samoila, Raymond Elwood and Justin Quinn

In the words of Charles F. Kettering, “If you have always done it that way, it is probably wrong”. This is exactly what the infection prevention and control (IPAC) department at Hôtel-Dieu Grace Healthcare (HDGH) found was occurring with their current Personal Protective Equipment (PPE) practices.    Regular quality checks identified that the current system of storing PPE on a series of carts throughout HDGH did not facilitate best practices for donning or hand hygiene.  Growing linen costs and lingering low hand hygiene compliance rates were also driving the need for a better PPE storage solution.

To find a better way, an inter-professional team was created including infection prevention and control, environmental services, materials management, frontline staff, ergonomics, clinical practice and plant operations.  The team conducted a comprehensive audit of the current state, focusing on identifying adherence to best practices for hand hygiene and donning of PPE throughout the organization.

The audit revealed extreme hoarding of linen, expired PPE and the regular storage of other general hospital supplies on the carts.  The manual replenishment of PPE on the carts without a defined process of ownership, cleaning and maintenance was found to be contributing to the hording and storage problems.   Further, the audit illustrated that health care workers were unclear about purpose of the PPE storage carts, and that the current storage system was contributing to missed hand hygiene opportunities and the growing linen costs.

With the audit results in hand, and with an understanding of best practices for PPE location and use, the inter-professional team was able to generate a list of criteria for ideal PPE storage at point-of-care.  This, coupled with extensive consultation with front line staff across the organization and through discussions with several vendors and suppliers, a new system for PPE storage at HDGH was designed.

The team found it relatively straightforward to find existing solutions with vendors for mask and glove storage and placement. Gloves were moved to in room point-of-care wall-storage holders, which were stocked with all sizes.   These were located next to wall, hand sanitizer dispensers to enable staff to perform hand hygiene and change gloves at point-of-care.   Based on a risk assessment for our campus, only one type of facial protection mask with an attached faceshield was made available to staff.

At HDGH, level two, impermeable, launderable gowns are used.   An existing solution for gown storage at HDGH was not as easy to identify.   This required the team to collaboratively develop a new innovative solution to meet our specific needs. After research and analysis by the team, a custom-made PPE gown storage solution was created.   This innovation included the storage of all gowns in laundered bags hung outside of each room.   The gowns are delivered to HDGH in pre filled 20 gown bags, the volume of which was calculated based on parameters related to the weight and height of the wall hooks and the number of gowns required in a 12 hour time period.

The team used a Plan-Do-Study-Act Quality Improvement Cycle to support the standardized adoption of the appropriate donning sequence of PPE and four moments of hand hygiene using the new system.  The impact of the new PPE storage system indicated some significant changes, including:

• A 27 per cent reduction in protective gown consumption, representing a cost savings of $24,706.91 in a one year period
• An eight per cent reduction in glove consumption, representing a cost savings of $56,000 over a three year period
• A 10 per cent increase in hand hygiene compliance over a two year period

The successful implementation of this new system at HDGH illustrates that great ideas can come from within the organization and that innovation does not always need to be “State of the Art” in order to be successful.   By using a collaborative, inter-professional team approach, and by including front line staff in the design, an innovative point of care PPE storage system can be successfully developed and integrated into practice.

Lindsay Samoila, Raymond Elwood and Justin Quinn work at Hotel Dieu Grace Hospital.