scholarly journals Pitfalls of a Staged Implementation of an Automated Hand Hygiene System: Lessons Learned

2020 ◽  
Vol 41 (S1) ◽  
pp. s353-s353
Author(s):  
Lori Sisler ◽  
Kathy Nigh
Keyword(s):  
Hand Hygiene ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Blood Stream ◽  
Central Line ◽  
Lessons Learned ◽  
Improve Hand Hygiene ◽  
Reminder System ◽  
Implementation Team

Background: Hand hygiene is the first defense against healthcare-associated infections, yet studies show that adherence to hand hygiene still remains low. An academic medical center selected a beacon-based automated hand hygiene reminder system to improve hand hygiene adherence. Accountability is challenging to enforce without a reliable means to measure hand hygiene adherence. The hospital used secret shoppers to observe hand hygiene adherence. This method captures an estimated 0.5%–1.7% of opportunities and may be influenced by the Hawthorne effect. Methods: In November 2018, a phased trial of an electronic hand hygiene reminder system began in 4 intensive care units (ICUs). The system selected used a badge and beacon technology. The badge identifies each care provider and displays colored lights to show adherence status. Beacons are present on the patient’s bed, soap, and hand sanitizer dispenser. These beacons establish a “patient zone” that captures opportunities for hand hygiene. The specialty beds in the ICUs were supposed to remain on the units. A patient transferring to a lower level of care would be placed on another bed or gurney when leaving the ICU. ICU staff were badged for the system. Results: The phased implementation strategy had challenges with beds, badges, and the system. Despite planning, education, and communication, the beds left the ICU area, so the beaconed beds were outside the ICU, and staff did not always wear their assigned badge. There were issues with the system router as well. Unit leadership and the infection control team worked on processes to get beds back into the units. The implementation team decided to provide badges to staff who regularly worked in the ICU to differentiate from consultation groups that came to the ICU (and were not badged). The system routers were plugged in at various places on the units and had become unplugged so information was not sent for reports. Despite these issues, over the year of implementation, the units did achieve an increase in hand hygiene adherence from 48% to 85%. Collectively, the units achieved a 53% reduction in central-line–associated blood stream infection (CLABSI), reducing infections from 13 to 7 and a 35% reduction in methicillin-resistant Staphylococcus aureus (MRSA), reducing infections from 8 to 3 as defined by the NHSN. Conclusions: When implementing a beacon-based, automated hand hygiene system, staged implementation can be challenging. To avoid these challenges, facility-wide implementation is preferable.Funding: NoneDisclosures: None

scholarly journals A Prospective Controlled Trial of an Electronic Hand Hygiene Reminder System

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Richard T. Ellison ◽  
Constance M. Barysauskas ◽  
Elke A. Rundensteiner ◽  
Di Wang ◽  
Bruce Barton
Keyword(s):  
Hand Hygiene ◽  
Real Time ◽  
Healthcare Workers ◽  
Medical Center ◽  
Controlled Trial ◽  
Academic Medical Center ◽  
Controlled Clinical Trial ◽  
Improve Hand Hygiene ◽  
Reminder System ◽  
Hygiene Compliance

Abstract Background.  The use of electronic hand hygiene reminder systems has been proposed as an approach to improve hand hygiene compliance among healthcare workers, although information on efficacy is limited. We prospectively assessed whether hand hygiene activities among healthcare workers could be increased using an electronic hand hygiene monitoring and reminder system. Methods.  A prospective controlled clinical trial was conducted in 2 medical intensive care units (ICUs) at an academic medical center with comparable patient populations, healthcare staff, and physical layout. Hand hygiene activity was monitored concurrently in both ICUs, and the reminder system was installed in the test ICU. The reminder system was tested during 3 administered phases including: room entry/exit chimes, display of real-time hand hygiene activity, and a combination of the 2. Results.  In the test ICU, the mean number of hand hygiene events increased from 1538 per day at baseline to 1911 per day (24% increase) with the use of a combination of room entry/exit chimes, real-time displays of hand hygiene activity, and manager reports (P < .001); in addition, the ratio of hand hygiene to room entry/exit events also increased from 26.1% to 36.6% (40% increase, P < .001). The performance returned to baseline (1473 hand hygiene events per day) during the follow-up phase. There was no significant change in hand hygiene activity in the control ICU during the course of the trial. Conclusions.  In an ICU setting, an electronic hand hygiene reminder system that provided real-time feedback on overall unit-wide hand hygiene performance significantly increased hand hygiene activity.

scholarly journals 1189. Effectiveness of Multimodal Intervention Strategies to Improve Hand Hygiene Compliance at an Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S426-S427
Author(s):  
Bhagyashri D Navalkele ◽  
Myrtle Tate ◽  
Jeff Dunaway ◽  
Sheila Fletcher ◽  
Barbara Inman ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Strategies ◽  
Improve Hand Hygiene ◽  
Early 19Th Century ◽  
Study Objective ◽  
Multimodal Intervention ◽  
Hygiene Compliance

Abstract Background Since the early 19th century, hand hygiene (HH) has been recognized as the most important factor in preventing healthcare-associated infections (HAI). Still, improving HH compliance is a major hurdle for most healthcare facilities. Our study objective was to evaluate effectiveness of bundled intervention tools in increasing hand hygiene (HH) compliance. Methods The study was performed at the University of Mississippi Medical Center located in Jackson, MS. A multidisciplinary HH team was established in January 2016. Team members included infection prevention, nurse managers, physician, resident, housekeeping, process engineers, and ancillary staff. Hand hygiene compliance was determined based on room entry and exit observations. Intervention strategies were based on Joint Commission Center’s Targeted Solutions Tool (TST) to identify barriers in HH compliance, standardization of data collection, covert observer training and Just-in-time training of providers. Other strategies implemented included education and feedback, rewards and recognition, and system change measures during the 3-year study period (timeline in Table 1). Hand hygiene compliance was calculated based on number of compliance opportunities/total number of observations. One-way Analysis of Variance (ANOVA) was performed to analyze HH data. We did not assess the concomitant reduction in HAI rates as simultaneous HAI prevention strategies confounded analysis. Results Based on total 95,491 observations performed (January 2016- December 2018), there was a statistically significant improvement in HH compliance during the study period from 66.5% in 2016 to 73% in 2017 and 79.5% in 2018 (P = 0.04). Conclusion At our institution, we observed a 56% improvement in hand hygiene compliance over 36-months timeframe. Multidisciplinary team involvement and multimodal intervention strategies play crucial role in improvement and sustainment of HH compliance. Disclosures All authors: No reported disclosures.

scholarly journals Using targeted solution tools as an initiative to improve hand hygiene: challenges and lessons learned

2017 ◽  
Vol 146 (2) ◽  
pp. 276-282 ◽  
Author(s):  
J. A. AL-TAWFIQ ◽  
M. TREBLE ◽  
R. ABDRABALNABI ◽  
C. OKEAHIALAM ◽  
S. KHAZINDAR ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Blood Stream ◽  
Lessons Learned ◽  
Healthcare Associated Infection ◽  
Contributing Factors ◽  
Improve Hand Hygiene ◽  
Hygiene Compliance ◽  
Tract Infections

SUMMARYThe Joint Commission Centre for Transforming Healthcare's Web-based Targeted Solutions Tool (TST) for improving hand hygiene was implemented to elucidate contributing factors to low compliance rates of hand hygiene. Monitoring of compliance was done by trained unknown and known observers and rates of hospital-acquired infections were tracked and correlated against the changes in hand hygiene compliance. In total, 5669 of hand hygiene observations were recorded by the secret observers. The compliance rate increased from 75·4% at baseline (May–August 2014) to 88·6% during the intervention (13 months) and the control periods (P < 0·0001). Reductions in healthcare-associated infection rates were recorded for Clostridium difficle infections from 7·95 (CI 0·8937–28·72) to 1·84 (CI 0·02411–10·26) infections per 10 000 patient-days (P = 0·23), central line-associated blood-stream infections from 5·9 (CI 1·194–17·36) to 2·9 (0·7856–7·475) per 1000 device days (P = 0·37) and catheter-associated urinary tract infections from 5·941 (CI 1·194–17·36) to 0 per 1000 device days (P = 0·42). The top contributing factors for non-compliance were: improper use of gloves, hands full of supplies or medications and frequent entry or exit in isolation areas. We conclude that the application of TST allows healthcare organisations to improve hand hygiene compliance and to identify the factors contributing to non-compliance.

Lessons learned from a hospital‐wide review of blood stream infections for paediatric central line‐associated blood stream infection prevention

2018 ◽  
Vol 55 (6) ◽  
pp. 690-694
Author(s):  
Anita J Campbell ◽  
Christopher C Blyth ◽  
Christopher J Hewison ◽  
Yu‐Ping Chen ◽  
Leanne Gough ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Lessons Learned ◽  
Blood Stream Infections

scholarly journals Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

2020 ◽  
Vol 7 (4) ◽  
pp. 739
Author(s):  
Mohamed Farouk M. Ibrahim ◽  
Hanem Abdullah Mohamed ◽  
May Abdelfattah ◽  
Sara S. ElTatawy
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Hospital Stay ◽  
Neonatal Intensive Care ◽  
Blood Stream Infection ◽  
Length Of Hospital Stay ◽  
Blood Stream ◽  
Central Line ◽  
Survey Study ◽  
P Value

Background: Device Associated Infection (DAI) namely Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infection (CLABSI) is one of the challenges for both neonatal nurses and doctors. Aims of the study were 1) Assess the rate of DAI occurrence among neonates, 2) explore the relationship between DAI rates and certain risk factors such as nurse patient ratio, hand hygiene practice, gestational age (GA), weight, and length of hospital stay among neonates.Methods: Descriptive correlational survey research design. Sample: All neonates admitted in twelve months-duration were included (total number 1090 neonates). Nurses and doctors were observed for compliance to adequate hand hygiene technique. Tools: 1) Center for Disease Control (CDC) criteria to calculate DAI rates, 2) Hand hygiene five points checklist 3) Review of neonates charts to collect data as weight, GA 4) Ballard score and 5) nurse/patient ratio.Results: 24 neonates developed DAI, high significant negative correlations between DAI and infants’ weight, GA, nurse/patient ratio and overall compliance to hand hygiene techniques were reported (p-value ≤0.05). Length of hospital stay, inadequate hand hygiene technique had strong positive correlations with DAI rate (p-value ≤0.05).Conclusions: Factors that could affect DAI were infant’s weight, GA, length of hospital stay, inadequate hand hygiene technique and nurse/patient ratio. Recommendations: implementation of infection control programs to raise nurses as well as physicians’ compliance to adequate hand hygiene technique and increase number of nurses in the Neonatal Intensive Care Unit (NICU) per shift.

scholarly journals 1174. The Impact of Multidisciplinary Central Line Stewardship Program to Decrease CLABSI Rates and Central Line Utilization Rates in an Academic Urban Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S420-S421
Author(s):  
Isha Bhatt ◽  
Mohamed Nakeshbandi ◽  
Michael Augenbraun ◽  
Gwizdala Robert ◽  
Michael Lucchesi
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Blood Stream ◽  
Central Line ◽  
Mandatory Reporting ◽  
Incidence Density ◽  
Post Intervention ◽  
Improvement Project ◽  
Stewardship Program ◽  
The Impact

Abstract Background Central Line-Associated Blood Stream Infections (CLABSI) is a major healthcare dilemma, contributing to increased morbidity, mortality, and costs. We sought to reduce rates of CLABSI and device utilization by implementing a multidisciplinary Central Line Stewardship Program (CLSP). Methods In July 2017, the CLSP, multidisciplinary quality improvement project, was implemented at an academic medical center to ensure proper indication for all CVCs in the hospital and removal when no longer indicated. A CLSP team of executive leaders and infection preventionists performed daily rounds on all CVCs to review indications and maintenance. Nursing staff reported all CVCs daily. Information Technology modified the electronic health record to require daily physician documentation of CVC placement and indications, and to suggest alternatives to CVC when possible. In the event of a CLABSI, a root cause analysis was conducted within 72 hours, and feedback was shared with the clinical staff. A retrospective review was conducted 18 months before and after CLSP implementation. As a facility in a state with mandatory reporting of hospital-acquired infections, institutional data were readily available through the National Healthcare Safety Network (NHSN). To compare rates of CLABSI and device utilization pre- and post-CLSP, we reviewed the Incidence Density Rate (IDR), the standardized infection ratio (SIR), and standardized utilization ratio (SUR). Data from the NHSN website were analyzed using statistical tools provided by the NHSN analysis module. Two-tailed significance tests were conducted with α set at 0.05. Results Post-CLSP, there was a statistically significant decrease in SIR from 1.99 to 0.885, with risk reduction by 44.3% (P = 0.013, 95% CI 0.226 -0.831). CLABSI IDR per 1000 CVC days declined from 1.84 to 0.886 (P = 0.0213). CVC utilization per 1000 patient-days reduced from 155.08 to 142.35 (P < 0.001). There was also a trend toward fewer PICC line infections post-intervention (17 to 5). Conclusion With this novel CLSP, we achieved a significant reduction in rates of CLABSI and device utilization, suggesting that a multidisciplinary approach can promote sustainable prevention of line-associated infections through dedicated surveillance of CVC indications and maintenance. Disclosures All authors: No reported disclosures.

scholarly journals Improved Survival of Candida CLABSI by Adherence to Standard of Care and Involvement of Infectious Diseases Consultant: A 5-Year Experience in a Single Academic Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S89-S89
Author(s):  
Blessy John ◽  
Maricar Malinis ◽  
Iyanna Fairweather ◽  
Michael Aniskiewicz ◽  
Jose Rivera-Vinas ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Academic Medical Center ◽  
Standard Of Care ◽  
Blood Stream ◽  
Central Lines ◽  
Candida Sp ◽  
Academic Center ◽  
Stage Renal Disease

Abstract Background Candidemia is the fourth most common nosocomial blood stream infection with significant morbidity and mortality. Central lines have been considered a risk factor for invasive fungal infection. We evaluated the epidemiology, management, and outcomes of Candida CLABSI in an academic medical center. Methods We conducted a retrospective cohort study in a single academic center from January 1, 2011 to December 31, 2016 of patients who had positive blood cultures for Candida sp. and met CDC criteria for CLABSI. Outcomes measured were 30-day mortality and relapse or recurrence. Descriptive statistics were used to compare the outcomes of patients who had infectious diseases consult and managed per standard of care (SOC) as defined by IDSA guidelines and those without. Results Of 722 CLABSI cases, 82 (11%) were due to Candida sp. Candida species isolated were as follows: C. glabrata (40%), C. albicans (32%), C. parapsilosis (9%), and others (19%). Median age of pediatric patients was 2.25 years (range 0.5–6) and median age of adults was 59 years (19–92). Most common comorbidities were malignancy (35%) and end-stage renal disease (21%). Non-tunneled catheters were present in 58% of cases. Median time from line placement to candidemia was 15 days (IQR 8–29). Sepsis was present in 34 (42%) cases. Seventy-four (90%) cases were initiated on antifungal therapy (AFT) when culture turned positive. After Candida speciation, AFT was adjusted appropriately for 82 (100%) cases. IDC was present in 56 (68%), of which 41 (73%) followed SOC, whereas 15 (27%) did not. Two of 26 patients (8%) without IDC received SOC. Complications occurred in 11/82 (13%) (three endocarditis, two osteomyelitis, three endophthalmitis, and four septic thrombophlebitis). Cure was achieved in 26/82 (32%). Relapse or recurrence occurred in 15/82 (18%). The 30-day mortality for the cohort was 50%. Patients with IDC who received SOC had lower mortality compared with those who did not (35% vs. 67%, respectively; P = 0.03). Conclusion Candida CLABSI was infrequent but had significant mortality in our cohort. Our results suggest that adherence to SOC per IDSA guidelines and involvement of IDC may improve survival of patients with Candida CLABSI. Future studies are needed to validate these findings. Disclosures All authors: No reported disclosures.

Achieving Zero Catheter Related Blood Stream Infections: 15 Months Success in a Community Based Medical Center

2007 ◽  
Vol 12 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Sophie A. Harnage
Keyword(s):  
Nursing Practice ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Blood Stream ◽  
Central Line ◽  
Community Based ◽  
Blood Stream Infections ◽  
Patient Morbidity ◽  
Surgical Icu ◽  
Inpatient Length Of Stay

Abstract Achieving Zero Catheter Related Blood Stream Infections: 15 Month Success In A Community Based Medical Center. Background and Purpose: Catheter related blood stream infection (CRBSI) is a major cause of patient morbidity, mortality, and cost. Lower CRBSI rates would decrease inpatient length of stay. Project: An innovative central line bundle was developed to reduce CRBSI. An innovative combination of focused nursing practice and product technologies were selected for the bundle and implemented through a defined educational program. Data was collected from thirty-two critical care beds: 16 medical/surgical ICU and 16 Trauma-Neuro ICU beds. Results: From January 2006 thru March 2007 there were Zero occurrences of CRBSI. Over this 15 month period our PICC insertions increased by 103%, and our interventional radiology referral rate decreased to less than 2%. Implications/Conclusions: A multimodality bundle, combining nursing practice interventions and technology can successfully decrease the incidence of CRBSI. While some of the bundle components have not been widely researched and instead are based on theory or accepted clinical practice, the early outcome provides a basis for additional study and refinement. It also invites research into the various components of the bundle to evaluate the effect each separate practice and product lends to its success.

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