Be the world’s leading away from home skin care system companyDeb Canada, 42 Thompson Road West, Waterford, Ontario, Canada N0E 1Y0 Tel: 1-888-332-7627 Fax: 1-800-567-1652

Improving Hand Hygiene Behaviour

Alberta Health and Wellness released MRSA Guide-lines (August 2007) and Standards (January 2008) that recommended both behavioural and surveillance practices to minimize risk of exposure to and transmission of MRSA to clients and sta�.

In September 2008 Safer Health Care Now! (SHN) Western Node issued a “Call for Action” asking for the participation of Health Care Organizations across the continuum of care. This 1 year collaborative focused on the prevention of and reduction in MRSA infections. The goal was to support organizations with the imple-mentation of intervention strategies that have been proven to promote improvements in patient safety and prevent adverse events. The Willow Creek Care

Centre (WCCCC) in Claresholm, Alberta chose to answer this call. The WCCCC is a freestanding Long Term Care facility in a rural community with 100 beds divided into 2 units.

With the support of the SHN Collaborative, participat-ing organizations developed frontline teams to work on 1 or more of 5 evidence based IPC interventions tailored to their setting (i.e., hand hygiene, environ-mental cleaning and disinfection, use of personal protective equipment, isolation practices and surveillance). The WCCCC chose to focus on hand hygiene practices on one of their units. The challenge with regard to implementation of the intervention was not the lack of knowledge about intervention but

The Claresholm Willow Creek Care Centre Hand Hygiene Team. Left to right: Gerry Laing RN, GNC(C), Nikki Yorgason HCS, Denise Pezderic HCA, Helen Johnson RN, BN, Mona Thiessen Housekeeping. Absent: Chris Coe HCA and Loree Preet

Facts

Who: The Willow Creek Care Centre (WCCCC) in Claresholm, Alberta

Daily Challenge: Improve Hand Hygiene Compliance.

Unique Response: Safer Health Care Now (SHN) MRSA Western Node Collaborative and Deb Canada Healthcare Hand Hygiene.

Be the world’s leading away from home skin care system companyDeb Canada, 42 Thompson Road West, Waterford, Ontario, Canada N0E 1Y0 Tel: 1-888-332-7627 Fax: 1-800-567-1652

Improving Hand Hygiene Behaviour Page 2

1. Taking Care of Basics: Evaluating Hand hygiene practice

For the �rst PDSA cycle, hand hygiene practice was assessed by observing 16 sta� members for a period of one half hour during morning care using the audit tool provided by SHN. Next, placement of hand hygiene dispensers was mapped, and then product and dispenser usage was evaluated using dispenser counters provided by Deb Canada. As WCCCC uses Deb Canada hand hygiene products and dispensers it was easy to place Deb Canada’s counters inside the dispens-ers. These counters measured the number of times a dispenser lever is pushed.

Data from the PDSA cycles showed a sta� HH compliance rate of 52.9% and that compliance fell between environ-mental and resident contact. If product was readily available sta� willingly used it, but would not go out of their way to use it even though they knew that they should. When asked about this behaviour “the time factor” as noted as the reason for lack of compliance. The dispenser counter audits showed which dispensers had high and low usage. This helped iden-tify which dispensers had been poorly located and where additional dispensers were needed.

2. Increasing a�ordancesBased on the data from the initials PDSA cycles hand hygiene products were made more accessible by relocating dispensers and adding Microsan alcohol hand rub dispensers in each resident room. Previously sta� only had access to resident hand wash sinks in resident bathrooms.

3. Education Opportunities:

A learning opportunity presented itself in the development of a Norwalk outbreak during the initial PDSA testing cycles. The outbreak occurred in the facility during the time dispenser counters were installed. Data from counters showed a sharp increase in all dispenser use, including soap

the ability to translate knowledge into practice through social and behavioural change.

The WCCCC implemented the Model for Improvement developed by Associates in Process Improvement. The model has two parts. The �rst comprises three funda-mental questions:

1. What are we trying to accomplish?

2. How will we know that a change is an improvement?

3. What changes can we make that will result in improvement?

The second part uses the Plan-Do-Study-Act (PDSA) cycle to implement and test changes in real life settings. By setting aims, establishing measures, selecting changes and testing changes the cycle provides a practical method for “small tests of signi�cant changes” that lead to “action-oriented learning”.

WCCCC change package

Gerry Laing RN, Education Coordinator “taking care of basics” ensuring correct placement of dispensers based on data from dispenser counters.

Be the world’s leading away from home skin care system companyDeb Canada, 42 Thompson Road West, Waterford, Ontario, Canada N0E 1Y0 Tel: 1-888-332-7627 Fax: 1-800-567-1652

Improving Hand Hygiene Behaviour Page 3

A combination of using glow germ on inanimate, high touch objects, tempera paint on gloved hands and chocolate pudding placed on sta� wearing gloves, gowns, mask and eye protection highlighted the need for and importance of hand hygiene.

4. Listen to your customers:Data from the initial PDSA cycles also indicated that Sta� are the best judge of where to place dispensers in their own work areas. Dispensers needed to be conveniently located in sta� work areas to maximize use. They needed to be at eye level and usually on the right hand side of exit/entrances to maximize use.

Data from the PDSA cycles showed that moving dispens-ers must be accompanied by signs. Signs drew attention to the dispensers and these signs had to be kept updated and fresh. A facility hand hygiene poster contest was developed after one sta� member placed their own hand made sign on a Microsan dispenser “the WCCCC clean machine”. Over time sta� involvement and participation increased on the study unit with increased suggestions, questions and requests for additional dispensers. The project became a collaborative e�ort that spread throughout the facility.

The project has now taken on a life of its own. Hand hygiene awareness spread from sta� to the residents. A campaign was started in the recreation / dining area, a public gathering place. Sta� were asked to do residents hands once additional Microsan dispensers had been appropriately placed around the area. Residents who are self su�cient are now using Microsan dispensers around the facility and increasingly residents are asking to be pushed up to dispensers.

and alcohol hand rub, during the outbreak. After the outbreak, dispenser use dropped back to pre outbreak levels. During the outbreak sta� received daily education on hand hygiene, isolation precautions and use of personal protective equipment. The invisible became visible for sta� as they could see the result of poor hand hygiene as evidenced by visible transmission of illness and symptoms of vomiting and diarrhoea.

This natural learning opportunity in�uenced facility educational approaches. Data from the dispenser counters helped sta� visualize their hand hygiene behaviour. Experience from the outbreak underscored the need for education to be multifaceted; it needed to be continuous and varied and that if sta� could see the results of non compliance with hand hygiene they would be more likely to understand the reason for hand hygiene. A hand hygiene education program was created with a focus on “Making the invisible visible”.

Participating in “making the invisible visible” education session Anna Greven RN, Dorothy Larson LPN and Gaylene Carlson RN are wearing their PPE covered in chocolate pudding.

For more information, please contact:Gwyneth Meyers BSc, MSc

Infection Prevention Control - RuralAlberta Health Services

(403) 955-2869 pager 04364gwyneth.meyers@albertahealthservices.ca

www.albertahealthservices.ca