PATIENT SAFETYSTARTS WITH ME! Baylor Health Care SystemHand Hygiene Initiative2008 - 2010 Irving Prengler, M.D., M.B.A. Chief Medical Officer Baylor University Medical Center
Baylor UniversityMedical Center Statistics • 37,238 admissions (including newborns) • 4,298 babies born • 56,570 emergency room visits • 254,382 outpatient visits(excluding home care and emergency department) • 1200 licensed beds • 1,250 physicians with active privileges • 185 medical residents and fellows • 5,225 employees
Baylor Health Care System • 23 owned, leased, affiliated and short-stay hospitals • 88 primary care centers, specialty care centers, senior health centers • 12 rehabilitation clinics • 17 ambulatory surgery centers • Baylor Research Institute • ODC Therapy, Inc.
Baylor Health Care SystemFiscal Year 2008 Statistics* • 109,881 admissions • 15,427 babies born • 310,535 emergency department visits • 556,577 outpatient registrations (excluding emergency department and home care visits) • 2,955 average of licensed beds • 18,000 employees • 2,886 physicians on active staff
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene Hand Hygiene is the single most effective intervention to reduce the cross transmission of healthcare associated infections
Why Measure Hand Hygiene? PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • Hands are the most common single source of HAI’s • Nationally, compliance for handwashing for HCW’s is only 40-60% • Hand hygiene reduces transmission of infections by HCW’s • Many quality improvement and consumer groups are demanding better performance from hospitals
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene Hand Hygiene Pioneers • Oliver Wendell Holmes • 1840’s in U.S. • Ignaz Semmelweiss • 1840’s: General Hospital of Vienna • First Clinic: Doctors and medical students • Second Clinic: Midwives
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • Lack of active participation at individual or institutional level • Lack of role model for hand hygiene • Lack of institutional priority for hand hygiene • Lack of administrative sanctions of noncompliers and/or rewarding compliers • Lack of institutional safety environment. Barriers to Hand Hygiene
Healthcare Organizations withSuccessful Programs PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • Novant Healthcare System • Cedars Sinai Hospital • Massachusetts General Hospital • Bronson Methodist Hospital • Canada
CEO BHCS CNO BHCS CMO BHCS VP Quality BHCS ID Physicians Public Relations – BHCS Nursing Directors Infection Preventionist Environmental Services Chief Nursing Officers BHCS HH Committee Members PATIENT SAFETYSTARTS WITH ME! Hand Hygiene Facility Based Hand Hygiene Teams • ID Physicians • General/Surgery Physicians • Nursing leadership • Infection Preventionist • Bed side Nurses • EVS • RT • PT • OR • Etc
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene Hand Hygiene Initiative Committee/Team Formation • Steering committee • Operations • Marketing/Public Relations • Education
AIM Statement PATIENT SAFETYSTARTS WITH ME! Hand Hygiene To increase the Baylor Health Care System hand washing compliance from the current rate to 85% by the end of June, 2009 and 95% by the end of June, 2010, thereby contributing to a projected 10% decrease in the number of healthcare associated MRSA infections, urinary tract infections, and central venous catheter associated bloodstream infections by the end of June, 2009 and 20% by the end of June, 2010.
Hand Hygiene Initiative Metrics PATIENT SAFETYSTARTS WITH ME! Hand Hygiene
3 Phases of the Campaign • Awareness/Education • Engagement • Accountability
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene Hand Hygiene Committee Recommendations • Develop non-verbal ways of communicating non-compliance • Make hand hygiene products readily available • Kiosks at entrances, floors • Small promotional products for personal use
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene Hand Hygiene Committee Recommendations • Distribute hand hygiene education posters throughout the institutions • Develop reward system for compliance • Develop education “flip and tell” for employees
Methods Used to Promote Improved Hand Hygiene PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • In-service education • Information leaflets • Workshops and lectures • Automated dispensers • Performance feedback on adherence rates • Patient/family involvement • Accountability
PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • Handwashing • Soap and Alcohol • Conveniently available everywhere • Everyone washes every time • Get patients involved Teach patients to say: “Please wash your hands before you touch me or any of my catheters.” Areas to Implement
Oliver Wendell Sutker 1840 PATIENT SAFETYSTARTS WITH ME! Hand Hygiene FOAM IN FOAM OUT
Patient Involvement PATIENT SAFETYSTARTS WITH ME! Hand Hygiene
Other Awareness / Education Resources • CDC Hand Hygiene Video placed on BTV in English and Spanish • Flip and Tell – Power Point Education
2009 Infection Prevention RetreatZero Tolerance for Infection: A Winning Strategy February 2009 • Healthcare Associated Infections • Change One Thing-Change Everything- The Power of One – Victoria Nahum • MedMined Introduction • Hand Hygiene Campaign and Best Practice • VAP and Best Practice • CL-BSI and Best Practice • SSI and Surgical Care Improvement Project • Clostridium Difficile Infection • CA-UTI and Best Practice
Hand Hygiene Information for Infection Prevention Summit PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • The two Hand Hygiene Campaign stories appearing in the July Baylor Progress online microsite at the launch of the campaign were the two most viewed stories that month with 655 and 609 views respectively. • The myBaylor.com Hand Hygiene page has received more than 5,000 hits since being posted in July. • Joel Allison’s video hand hygiene message to employees and physicians has been viewed online 663 times since August 1. • Patient Safety Tips posters that include a message about good hand hygiene are going up in all 3,000 patient rooms.
Taking it to the next level PATIENT SAFETYSTARTS WITH ME! Hand Hygiene • More patient and family involvement • Continue strong marketing effort • Maintain collegiality with firm expectations that everyone follows our policy • Empowerment • “Stop the line”
Handwashing Compliance PATIENT SAFETYSTARTS WITH ME!
BUMC-Hand Hygiene Total Compliance Rate 7/08 to 11/08 - 79.581% 7/08 to 2/09 – 79.955% Per 100 observations 20,542 observations
Top HH Compliance Rates • BMTU 91.234 • GI LAB 91.071 • 3/CCU 87.697 • 8R 86.977 • 2R So 85.366 • L & D 84.266 • 4T 84.104 • 4N 83.123 • 3H 82.727 • 4W 82.647
Bottom HH Compliance • 3T 63.3335 • 5H PACU 66.667 • 6T 72.27 • ED 72.7822 • 13R 74.114 • 5J 75.238 • 14R 75.484 • 2J 75.5 • 10R 75.537 • 2TW 75.907
Accountability • Hand Hygiene Goals have been developed for the system • Attached to performance appraisals • Cascaded down to all staff • Physician names are taken during audits • Physician receive letter from leadership • Chief receives letter if continues non compliance