New Guidance Shows Importance of Evidenced-Based Best Practices in Hygiene

A new guidance published in the August issue of Infection Control and Hospital Epidemiology emphasizes the importance of proper hand hygiene to prevent the spread of health care-associated infections, reports Health Canal. RWJF Health & Society Scholars program alumna Allison Aiello and her colleagues developed the guidance, which includes a series of evidenced-based best practices for optimal hand hygiene in health care settings. The guidance encourages increased availability and acceptability of certain soap and alcohol-based rubs and the development of a system to empower health care personnel to create a personalized hygiene system that gives them a way to track their progress.

The recommendations include developing a multidisciplinary team in which representatives from administrative and unit-level leadership work together to establish a hand hygiene program that best fits each institution. The program should include clear performance targets and an action plan for improving adherence, according to the guidelines.

An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of health care-associated infections. The study was conducted by David Thompson and Jill Marsteller associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton now at the Duke University Health System Patient Safety Center.

WIHI Event: No Excuses, No Slack! The Latest from the Front Lines on Hand Hygiene

The upcoming WIHI event,  "No Excuses, No Slack! The Latest from the Front Lines on Hand Hygiene" will be held March 7 from 2:00 – 3:00 PM ET and will focus on the importance of good hand hygiene in the prevention of infections.

As IHI points out in the promotion for this event, "among the biggest contributors to hospital-acquired infections are, inadvertently, health professionals themselves... and others who come in contact with patients."  During the live event, participants will have the opportunity to hear about increased awareness of this issue and compliance with strict hand hygiene requirements.

INQRI researchers David Thompson and Jill Marsteller appreciate the goals of this session. The goal of their INQRI-funded work was to implement a comprehensive safety program including an evidence based intervention to reduce central line-associated blood stream infections while examining the context of nursing care delivery on patient outcomes. The team conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. This study, conducted in ICUs in 12 states, has shown that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line insertion “checklist.” Hospitals that followed the components of their ICU safety program (which included a focus on hand washing), and adopted a safety improvement environment that fostered nurse involvement in quality improvement efforts, reduced, and in some cases completely eliminated, bloodstream infections for several months at a time. Their research is also showing that higher nurse turnover is related to higher infection rates.

Click here to enroll in the "No Excuses, No Slack" event.

Click here to learn more about the Thompson-Marsteller study and access publications from this work. 

Can a Necktie Make You Sick?

New legislation introduced in New York state would create an hygienic dress code for medical professionals in an attempt to reduce infections and thereby cut health care costs.

Syracuse's Post-Standard Editorial Board is encouraging of these efforts, but believes that to be truly successful at reducing facility acquired infections, a culture change is in order.  In their editorial, the board recommends that in addition to following a dress code, medical professionals should use checklists, commit to repeated hand-washing and consistently use gloves.

Click here to learn more.

Comment below to share your thoughts - can a necktie make you sick?

They All Agree...

...from Pronovost, to Gawande, to INQRI's own grantee team at Johns Hopkins, they all agree - handwashing is vitally important to fighting hospital-acquired infections.

Click here to learn how Abington Memorial Hospital in Pennsylvania addressed the problem head on, increasing their handwashing compliance from 31% in December, 2007 to 88% in September, 2009.

Nurses and Handwashing

In a new article, "Nurses lead the way in hand hygiene" from Endocrinology Update, Chris Kennedy writes:

"As a push for a national hand hygiene initiative gets underway, research has shown nurses outshine doctors and other medical staff by having the cleanest hands in the hospital."

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INQRI researchers are also recognizing the impact nurses can have in this arena. A research team at Johns Hopkins University has conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. There are some 80,000 catheter-induced bloodstream infections each year, causing up to 28,000 deaths. This study, conducted in ICUs in 12 states, has shown in preliminary analysis that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line-insertion “checklist.” Hospitals that followed the components of their ICU safety program, as well as adopted a safety improvement environment that fostered nurse involvement in quality improvement efforts, reduced, and in some cases completely eliminated, bloodstream infections for several months at a time. Their research is also showing that higher nurse turnover is related to higher infection rates.

Click here to read Chris Kennedy's article.
Click here for more information on the INQRI researchers.

Handwashing - It's Not Just for the OR

Yesterday, Pauline Chen, M.D. posted a terrific blog post about the importance of handwashing by medical professionals. In her piece "Why Don't Doctors Wash Their Hands More?" Dr. Chen outlines the important lesson she learned as a medical student...

"Within seconds the circulating nurse, the anesthesiologist and an operating room technician had hustled me over to a corner of the room. Standing in a semi-circle around me, they clucked their reprimands: You’ve got to be careful! Remember the sterile field! Just step away if you’re contaminated! Didn’t you pay attention? And, perhaps most humiliating: You medical students never learn!

If I hadn’t known it before, I knew it then. Hand hygiene and sterile technique are so successfully maintained in operating rooms not because of the reminders that hang over scrub sinks, but because it is part of the culture and identity of those who work there. No self-respecting surgeon, nurse, anesthesiologist or technician would ever dream of breaching those sterile protocols in the surgical suites. Or of allowing any deviation from the aseptic norms to simply pass."

But she continues to say that such dedication to handwashing does not continue outside of the operating room and wonders "Why Don't Doctors Wash Their Hands More?"

Click here to read the piece.

A team of INQRI researchers has found that handwashing is key to reducing infections. This team, at Johns Hopkins University, has conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. There are some 80,000 catheter-induced bloodstream infections each year, causing up to 28,000 deaths. This study has shown that substantial reductions in infections can be widely achieved, particularly when nurses lead the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line-insertion “checklist.” What makes the INQRI-funded work unique is that nurses drive the program in ICUs and they have achieved better results than have previous studies. Some of the components of the program include back-to-basics reminders such as having everyone who touches a central line wash their hands with soap and water; or ensuring that patients be fully covered by a sterile drape (except for a small hole where the line is inserted); or removing unnecessary lines from patients that can spawn infections. ICUs that have embraced this nurse-driven protocol have in many cases completely eliminated bloodstream infections among their patients for several months at a time.