CDC Hand Hygiene Saves Lives video found to empower patients to remind caregivers to wash their hands
Twice as many patients asked their caregivers to wash their hands after viewing the CDC video,
Hand Hygiene Saves Lives, according to preliminary research results from the CDC, Catholic Healthcare Partners (CHP) and the Premier healthcare alliance.
The research was conducted in 17 Catholic Health Partner (CHP) hospitals and tested the effectiveness of a CDC video to encourage patients, family and visitors to play a role in their own care by helping healthcare professionals remember to clean their hands before and after touching patients. After watching the video, the majority of patients:
reported that the video increased their knowledge
about hand hygiene;
reported that the video is a useful tool to educate
patients about hand hygiene; and
recommended that the video be shown to other
patients.
"Research has shown that hand hygiene adherence among medical professionals is less than optimal, despite long-standing evidence showing that it helps prevent healthcare-associated infections (HAIs)," said Dr. John Jernigan of the CDC. "This video is a tool hospitals can use to empower patients to participate in their own care and reduce their risk of acquiring an infection by reminding care givers to perform hand hygiene."
"Preventing HAIs is a high priority goal at all CHP hospitals, and we believe that patients can partner with us to assure safe and high-quality care," said Carolyn Weiging RN, BSN, CIC, Infection Prevention and Control Manager, St. Rita's Medical Center. "This video encourages that partnership by making it clear that it is perfectly acceptable to ask care givers to wash their hands to reduce their risk of infection."
The CDC Patient Admission Video, Hand Hygiene Saves Lives, was developed by the CDC in collaboration with the Association for Professionals in Infection Control and Epidemiology (APIC) and the Safe Care Campaign and is available free of charge from the Premier Safety Institute Safety Store or the CDC. To order the video (English and Spanish) and access more hand hygiene resources (links to tools, slides, posters) go to the Safety Institute at
www.premierinc.com/handhygiene
Hand hygiene: Easy, effective and Mom-approved for flu
It’s easy and it works just like your mother always told you it would. Thoroughly washing your hands with soap and water can help stop transmission of disease and keep you, your family and everyone you come in contact with healthier. Mom was right and there is more scientific proof supporting her admonition for hand washing. Soap and water, as well as the use of alcohol-based hand rubs, remove 2009 H1N1 flu microbes from hands.
A recent Australian study found that hand washing with soap and water or cleaning with alcohol-based hand rubs is highly effective in killing the 2009 H1N1 influenza virus. For the study, the hands of 20 vaccinated healthcare workers were contaminated with live H1N1. They were divided into five groups, each with a different hand hygiene protocol: Group 1 was the control group (no hand hygiene); Group 2 used soap and water; Group 3 used an alcohol-based gel product (61.5 percent ethanol gel); Groups 4 and 5 used products with alcohol combined with a chlorhexidine (CHG) solution (Group 4 used a 70 percent ethanol gel plus 0.5 percent CHG and Group 5 used a 70 percent isopropanol gel plus 0.5 percent CHG).
Washing hands with soap and water or rubbing them with either alcohol gels alone or in combination with CHG solution had an immediate reduction in the dried virus on the hands. However, the control group with no hand hygiene showed minimal reduction in H1N1 after 60 minutes. The results were dramatic even within a small sample.
Although the CDC hand hygiene guidelines support both soap/water and alcohol sanitizers as effective for pathogen removal, this study should remove any concerns whether that includes flu viruses; any type of hand washing, with soap and water or cleansing with hand sanitizers, can remove H1N1 from your hands.
Award winning H1N1 rap video promotes hand hygiene
Visit our Tools section and view Dr. John D. Clarke’s one-minute
award winning video on You Tube selected from more than 240 entries in a Department of Health and Human Services public service announcement contest about how to prevent the spread of influenza.
Checklists, system redesign, and
culture change essential to prevent HAIs
Attributing reduction of hospital-associated infections (HAIs) solely to a
checklist is tempting, but would be crucial mistake, obscuring the complex labor
involved to prevent HAIs. The potential for simple checklists to solve difficult
safety issues was popularized following a report on the Michigan Keystone ICU
program that resulted in a reduction of catheter-related blood stream infections
in the intensive care unit. The authors of a recent article in
The Lancet make the important point that the
shortcoming of the simple checklist story is in the assumption that a
technical solution such as checklists can solve
adaptive (socio-cultural) problems. Without a major focus to develop a
safety culture, checklists and other technical solutions are not readily
implemented by staff, the authors argue. Safer care is achieved when simple
steps in processes are identified, when measurement is carried out and outcomes
are fed back to staff; and when the culture supports expectations of building
performance standards into work processes.
Aspects of culture that support the success of a simple tool require the
evolution of a blame-free culture in which all team members are free to speak up
and stop a procedure because a breach in the protocol needs to be addressed –
e.g., hands not cleaned or a maximum barrier not in place during insertion of a
central catheters. Developing empowerment of nurses and other team members to
truly protect the patient in a blame-free environment is hard work. The authors
of
The Lancet article, who are members of the team that developed the
checklist as part of Michigan’s Keystone program, state that the program changed
workers’ motives for cooperating so that they internalized new norms. Adherence
to the checklist as a part of the process became a part of the culture, i.e.,
"the way we do things around here." They caution, however, that safety is
threatened if we believe that a simple and inexpensive tool can replace the hard
work of implementing the kind of cultural and organizational change effort that
is required for such tools to work successfully.
Simulation-based training on CVC insertion reduces catheter-related bloodstream infection in intensive care
Rates of catheter-related bloodstream infections (CR-BSI) were significantly reduced following completion of simulation-based learning programs in central-venous catheter (CVC) insertion among residents.
These findings come from a study conducted in an adult intensive care unit (ICU) in an urban teaching hospital with 92 internal medicine and emergency medicine residents having completed a simulation-based mastery learning program in CVC insertion skills.
The five-hour simulation program included a two-hour education session on technique, indications, contraindications, complications and a step-by-step demonstration of insertion technique based on evidence-based practices. The remaining three hours featured training with an ultrasonographic device and practice on a simulator. Residents were required to meet or exceed a minimum passing score or retest until passing score was reached.
Rates of CR-BSI from central venous catheters (CVCs) inserted by residents in the ICU before and after the simulation based educational intervention were compared over a 32-month period. The CR-BSI dropped from 3.2 to 0.5 infections per 1,000 catheter-days after the intervention.
CVC insertion usually involves learning at the bedside of actual patients without the opportunity for prior deliberate practice or skills assessment. Also, instruction in CVC insertion is important because traditional methods of procedural training are often inadequate, and education has been shown to reduce complications. The recent decision by the Centers for Medicare & Medicaid Services to reduce reimbursement for potentially preventable conditions as CR-BSI has highlighted one more reason to reduce complications related to CVC insertion. Improper insertion is one of the risk factors for CR-BSI and simulation-based education is one more tool to improve the skill on insertion of CVCs.
These results add to the growing body of literature documenting that simulation-based education improves the quality of care patients receive in such diverse areas as laparoscopic surgery, bronchoscopy, emergency airway management and endoscopy.
Study shows video games can enhance surgical skills
Video games with high visual-spatial demands and visual similarity to endoscopy improved performance in virtual reality endoscopic surgical simulation and can serve as effective training tools for developing surgical skills.
A randomized controlled trial found that medical students assigned to an intensive regimen of playing "shooter" video games (requiring high visual-spatial demands similar to endoscopy) demonstrated significantly superior endoscopic abilities than students who played a computer chess game or no video games at all.
Navigation skills: The game Half Life was chosen for one of the experimental groups because it has similarities with virtual endoscopy where navigation is a key element in performance scores.
Cognitive strategies skills:Chessmaster was chosen for the other experimental group because its task is laden with general cognitive load and strategy, rather than visual navigation.
The group training with Chessmaster showed some improvement, but the group training with
Half Life showed greater improvement. No effect was observed in the control group; overall findings supported the hypothesis that navigation skills would be more important than cognitive game skills.
The potential of video games as training tools to enhance the acquisition of basic technical skills in endoscopic simulation apart from traditional virtual reality surgical simulator training is evident in these findings. The authors note that
traditional virtual reality simulators for image-guided surgery usually cost millions of dollars to develop and deploy. This study showed that serious games tailored for education and training can be used and developed that enhance performance in the intense, visual-spatially challenging techniques required in surgery.
No more National Patient Safety Goals for now – key goals moved into standards
No new National Patient Safety Goals (NPSGs) have been issued for 2010 according to the Joint Commission, although changes to the current goals have been made, with some changes effective immediately. As the 2009 goals were clarified and streamlined, some requirements were moved to the standards and some were deleted. Effective immediately, the requirements that were deleted will not be reviewed in on-site surveys.
Importantly, the requirements for NPSG 7 related to healthcare-associated infections (HAIs), which were introduced incrementally in 2009, must be fully implemented in 2010.
The 2010 NPSGs reflect The Joint Commission’s continuing efforts to put the spotlight on those topics that are of highest priority to patient safety and quality care. Decreasing the number of NPSGs allows organizations to focus their efforts on the most urgent issues. Moving a requirement to the standards means that the requirement is still important, but it is no longer necessary to highlight the issue.
Requirements that were moved to the standards, and thus are still requirements, include elements related to topics such as verbal orders, medication safety and fall reduction programs.
Requirements that were deleted, and thus are no longer requirements effective immediately, include topics such as managing sentinel events related to HAIs, such as unanticipated death or permanent loss of function or a description of measures taken with surgical patients to prevent adverse events.
The Joint Commission did not include the medication reconciliation goal (NPSG 8) in these changes because it is still being evaluated and refined; it expects to send a revised version of the NPSG to field review in early 2010 and for approval by the Standards and Survey Procedures Committee in spring 2010.
Many elements of these topics remain and details can be found in the September 9 issue of
Joint Commission Online.
Elderly still at high risk for falls – AHRQ cites one in 10 ED visits
Falls are the most common cause of fatal injuries among elderly adults age 65 years and older, as well as the most common cause of nonfatal injuries in this population. Each year, approximately one-third of elderly adults experience a fall. This information comes from the Agency for Healthcare Research and Quality’s (AHRQ)
latest report based on 2006 Healthcare Cost and Utilization Project (HCUP) data. Fractures were the most common injury (41 percent), more than half of which resulted in admission to the hospital. Next most common were superficial/contusion injuries (22.6 percent) and open wounds (21.4 percent). Hip fractures accounted for about one in eight injurious fall-related ED visits among the elderly. About 41 percent of patients with fractures and 33 percent with internal organ injuries were transferred to a long-term care facility.
As with all types of fractures, elderly women were more likely to have ED visits for upper extremity and hip fractures than elderly men (79.4 percent women versus 20.6 percent men for upper extremity fractures; 74.6 percent women versus 25.4 percent men for hip fractures).
The direct medical cost for fall-related injuries among the elderly is about $20 billion annually. The total cost of hospital care following an ED visit for an injurious fall among the elderly totaled $6.8 billion in 2006.
Strategies to prevent falls can be found at the Premier Safety Institute’s
fall prevention Web site, focusing on preventing readmissions and providing care across the continuum. With fall rates continuing to be so high, and understanding the importance of the continuum of care, more effort and attention to risk assessment and discharge planning are needed to take advantage of community-based fall prevention programs.
Post-op complications may not always be preventable – but mortality can be, with effective management
Effective management of surgical complications once they have occurred appears to be equally important as preventing complication in reducing deaths following surgery.
Reducing rates of postoperative complications is the current focus of payers and regulators who have introduced initiatives and incentives to prevent and reduce complications associated with mortality. It has been a commonly held view that higher rates of deaths following surgery in certain hospitals are due to a higher rate of postoperative complications. But a
new study shows that the hospital’s ability to manage complications after they occur is actually the key factor in whether patients die from complications.
Researchers studied 84,730 people who underwent inpatient general or vascular surgery at 186 hospitals from 2005 to 2007. They found that death rates varied from 3.5 percent to 6.9 percent, but rates of complications were fairly constant across all the hospitals. The study is based on data from the American College of Surgeons’ National Surgical Quality Improvement Program.
The study found that patients who were treated at very-high-mortality hospitals had nearly two times the likelihood of dying after the development of a major complication as did their counterparts in very-low-mortality hospitals. Complications included major surgical site infection, post-operative bleed and myocardial infarction. Deaths included at least one major complication.
The ability to effectively rescue a patient from a complication relies on the timely recognition of a complication, and the effective management of that complication, including such measures as timely administration of antibiotics in patients with sepsis, rapid transfer of a patient to an intensive care unit (ICU) and availability of interventional cardiologists during an acute myocardial infarction.
Clearly efforts that are aimed at reducing rates of surgical complications also are essential. In this study, approximately one in six patients who underwent general or vascular surgery had a surgical complication, and more than half of such complications were serious. However, it is also critical to have the capability to recognize and manage complications.
Hospital design based on patient and worker safety needs addressed in new standards for hospital construction
Wider doors and ceiling-mounted lifts for bariatric units, cleanable privacy curtains in oncology units
and sink design are among the new standards addressed in the Facility Guidelines Institute’s (FGI) 2010 edition of Guidelines for Design and Construction of Health Care Facilities, published by the American Society of Healthcare Engineering (ASHE) of the American Hospital Association. The guidelines address many new issues and include updated requirements for the design of hand washing stations and selection of cleanable surfaces and furnishings.
The FGI recently announced publication of the 2010 edition of the guidelines, which are updated every four years and currently used by more than 42 states and several federal agencies to regulate healthcare facility design and construction in the United States.
The 2010 revision cycle has resulted in a document with much new text and updates to the language of the 2006 edition of the
Guidelines. Completely new language includes material on preparation of a patient handling and movement assessment (PHAMA) as part of planning for healthcare facility projects; recommendations for the design of bariatric and medical oncology units and cancer treatment facilities; and guidance on acoustic design for healthcare facilities. A detailed white paper describing how to prepare a PHAMA will be available for download from the FGI Web site in January 2010, accompanying the release date of the 2010 edition.
Another significant change to the Guidelines is the incorporation of the 2008 edition of ANSI/ASHRAE/ASHE Standard 170:
Ventilation of Health Care Facilities as Part 6 of the document. This merger is intended to eliminate any confusion caused by having two national ventilation standards for healthcare.
The 2010 edition is being published in three formats – a bound book, a loose-leaf version for placement in a three-ring binder, and a searchable CD.
H1N1 rap video - Award winning video promotes hand hygiene
Dr. John D. Clarke’s video was the winning entry selected from more than 240 entries in a Department of Health and Human Services contest that called for public service announcements about how to prevent the spread of influenza. The one-minute segment along with a public service announcement from Dr. Clarke can be viewed at
www.youtube.com/watch?v=_gwUdmPl0bU
Looking for free tools and resources for your safety program? Visit the Premier Safety Institute’s® Safety topics A to Z section of its Web site for a listing of hundreds of free
safety tools
These tools and resources are compiled from each issue of Premier’s electronic
SafetyShare® newsletter. They are nearly all free, being selected from among those that are publicly available or deemed as extremely useful by our Safety Institute team. The tools are organized for easy location by topic and readily available from Premier Safety Institute’s
safety topics A to Z Web site.
The
University of Michigan Health System Patient Safety Toolkit addresses the full spectrum of best practices and practical applications for programs in all areas basic patient safety principles. Each topic has a wealth of content that enables benchmarking of programs. For example, in infection control, after describing key components of a program, practical tools such as organization charts based on program principles, job descriptions and checklists for outbreak investigations are easily located and immediately usable, along with literature and other tools and templates. Chapter topics include safety culture, safety plans, safety curriculum, adverse events, medication safety, infection control and disclosure. The tool kit was designed by professionals in risk management, quality improvement, nursing, pharmacy and infection prevention.
A new
podcast is available from the CDC to educate the public about antibiotic resistance. The podcast features a pharmacist counseling a frustrated mother about appropriate antibiotic use and symptomatic relief options for her son's cold. This podcast helps the lay person gain a greater understanding of the causes and problems associated with antibiotic resistance. There is a link from the podcast home page to additional information on appropriate antibiotic usage.
Follow the Premier Safety Institute on Twitter; H1N1 flu and hand hygiene resources
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To sign up, go to www.twitter.com, click on the "Sign up now" button, pick a user name, and "tweets" or messages will be delivered to your choice of e-mail, phone, laptop or handheld device. Then go to
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About Premier Inc., 2006 Malcolm Baldrige National Quality Award recipient
Serving more than 2,100 U.S. hospitals and 53,000-plus other healthcare sites, the Premier healthcare alliance and its members are transforming healthcare together. Owned by not-for-profit hospitals, Premier operates one of the leading healthcare purchasing networks and the nation's most comprehensive repository of hospital clinical and financial information. A subsidiary operates one of the nation's largest policy-holder owned, hospital professional liability risk-retention groups. A world leader in helping healthcare providers deliver dramatic improvements in care, Premier is working with the United Kingdom's National Health Service North West and the Centers for Medicare & Medicaid Services to improve hospital performance. Headquartered in San Diego, Premier has offices in Charlotte, N.C., Philadelphia and Washington. For more information, visit www.premierinc.com.
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