QI: NOSOCOMIAL INFECTIONS

HAND
HYGIENE

Spring 2015, N362

Veronica Alvarez, Elizabeth Chang-Saito,
Susan Kim, Carissa Pekelo-Delgado, and Sophia Soriano-Castillo

http://youtu.be/M8AKTACyiB0
http://youtu.be/s08yiZBSGOw

Why should health care

professionals be concerned
about Hand Hygiene?
According to the WHO (World Health Organization), hands are THE
MAIN PATHWAY of germ transmission during health care (n.d.)

SCIENCE evidence:
The surfactants in soap lift soil and microbes from skin (CDC 2014)
Removing germs through hand washing helps prevent diarrhea and
respiratory infections and may also prevent skin and eye infections
(CDC 2014)
Washing hands prevents illnesses and spread of infections to others
(CDC 2014)
FACT: A single gram of human feceswhich is about the weight of a
paper clipcan contain one trillion germs (CDC 2014)
According to the CDC, nearly 2 million patients in the U.S. get an HAI, and
about 90,000 of these patients die from an HAI (2015).

**Approximately 1 in 25 patients in the U.S. have contracted at

least one infection during the course of their hospital care **

Key Players

RNs
LPNs
CNAs
Doctors

PTs
RDs

SWs
Chaplains

RTs
OTs

Housekeeping

5 Moments of Hand Washing

(WHO, n.d.)

Hawaii and National Statistics

for HAIs
(DOH 2014)

ROOT CAUSE ANALYSIS

Baseline data collection:
Investigate patterns of negative effects
Incidence of HAIs
Hand hygiene measurement methods
Direct observation to monitor hand-hygiene using
Five Moments of Hand Washing
Measuring hand hygiene product consumption
Surveys: self-report and patient observations
Causal factor charting:
Ability: correct hand washing techniques, adequate supplies
Opportunity: conveniently placed supplies, time
Motivation: institutional hand hygiene policy, understanding of the
transmission of organisms

ROOT CAUSES IDENTIFIED

According to 2010 study by the Health Research & Educational Trust, main
causes of failure to clean hands:
Ineffective placement of
dispensers or sinks
Lack of accountability
Safety culture does not stress
hand hygiene
Insufficient education
Hands full
Gloves
Healthcare workers forget
Distractions

ACTION STEPS: PLAN

Goal: To increase hand hygiene
compliance in order to reduce
incidence of nosocomial infections.
Preferred Outcomes: Hand hygiene
compliance will INCREASE by at
least 50%. This will be monitored
monthly, through a reporting system
via bar, pie, and flow charts.
Implementations to reach goal:

Ensure adequate placement

of sanitizer dispensers and
sinks

Assess staff knowledge and

provide education

Assess compliance

Hand Hygiene Compliance

ACTION STEPS: DO
Ensure adequate placement of sanitizer dispensers and sinks
Ensure dispensers and sink are at all patient rooms, nurses stations, hallways
Have dispensers available at each end of the nursing station and in the hallways.
Ensure unit has storage for essential supplies for hand washing and that staff have
access to its location.
Notify CN when essential supplies for hand washing are low.
Provide alternative soap for hypersensitive skin.

Assess knowledge of staff on material-based:

Provide ongoing in-service and literature regarding standards of hand washing
Provide monthly updates on hand hygiene compliance
Post simple signs for each action. Eg. WET, LATHER, SCRUB, RINSE, DRY
Clarify staff the difference with handwashing with soap and use of hand sanitizer

Assess adherence of staff on application-based:

Conduct live demonstration of proper hand washing via staff participation.
Initiate random observational assessments
Observations will take place twice a day for 15 minute intervals.

NURSING PROCESS FOCUS TO

PROMOTE CHANGE
ASSESS:

INTERVENE:

Motivation to perform
hand hygiene
Knowledge on proper
hand hygiene technique
Awareness of
occurrence and

percentage
Survey barriers to proper
hand hygiene that are
specific to facility

Ensure availability of
alcohol-based hand rub
stations at the point of
care in all patient care
areas and that they are
fully stocked.
Using fluorescent dyebased training methods
to demonstrate proper
hand hygiene techniques
to clinical staff
Provide education where
knowledge is lacking
Badge system to collect
subjective data

EVALUATE:

Obtain patients
feedback.
Relay results of
undercover
observation to nursing
manager and compare
results with previous
observations
Collaborate with
Infection Control Team
to discuss trend of HAIs
If/when implemented,
badge system stats.

ACTION STEPS: CHECK AND ACT

Check:

Measuring the amount of

soap/alcohol based hand
rub regularly. Make sure
dispensers work properly.
Continue to have random
observational
assessments for staff,
correct staff if needed.
Have staff fill out survey
with monthly updates on
hand hygiene
compliance.
Allow patients to fill out
survey about whether or
not they see staff
washing their hands

Act:

Review proper hand

washing technique with
staff
Regularly check to make
sure dispensers are well
placed and working.
Measure how much liquid
soap/alcohol hand rub is
used to properly wash
hands
Perform random hand
washing assessments
Fill out and manage
surveys to measure
compliance.

References
Centers for Disease Control and Prevention. (2015, January 13). State based HAI prevention. Retrieved February 3, 2015,
from http://www.cdc.gov/HAI/stateplans/state-hai-plans/hi.html
Centers for Disease Control and Prevention. (2014, October 17). Show me the sciencewhy wash your hands. Retrieved
February 20, 2015 from http://www.cdc.gov/handwashing/why-handwashing.html
Dark Daily. (2012, April 4). Clinical Laboratory and Pathology news and trends. Retrieved February 8, 2015, from
http://www.darkdaily.com/public-reporting-of-hospital-acquired-infection-rates-still-not-required-by-a-majority-of
states-40312#axzz3RENTgK8B
Health Research & Educational Trust. Hand Hygiene Project: Best Practices from Hospitals Participating in the Joint
Commission Center for Transforming Healthcare Project. Chicago: Health Research & Educational Trust, 2010.
Infection Control Today. (2012, December 2). Infection Control Today. Retrieved February 8, 2015, from
http://www.infectioncontroltoday.com/Galleries/2012/11/National-Handwashing-Awareness-Week.aspx
Mind Tools. Root Cause Analysis. Tracing a Problem to its Origins. Retrieved February 8, 2015 from
http://www.mindtools.com/pages/article/newTMC_80.htm
Larson, E., Goldmann, D., Pearson, M., Boyce, J., Rehm, S., Fauerbach, L., ... Pittet, D. (2009, January 1).
Measuring
Hand Hygiene Adherence: Overcoming the challenges. Retrieved February 20, 2015, from
http://www.jointcommission.org/assets/1/18/hh_monograph.pdf
World Health Organization. (n.d.). Hand hygiene: Why, how & when?. Retrieved February 3, 2015, from
http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_andWhen_Brochure.pdf