Hand-washing compliance goes from 33% to 95%
Hand-washing compliance goes from 33% to 95%
Steering team of key players drives process
If at first you don't (totally) succeed, keep trying . . . That should be the motto of the quality leaders at Bay Medical Center in Panama City, FL. Not content with QI efforts that boosted their staff hand-washing compliance from 30%-33% to 65%-75%, they implemented additional strategies that got compliance all the way up to 95%.
A team effort spearheaded by a multidisciplinary steering team and the decision to take responsibility for hand hygiene out of the infection control department and making it a hospital-wide initiative were among the keys to success, says Robert Campbell, PharmD, director of performance improvement, patient safety, and regulatory compliance.
"We started a throughput initiative as part of our performance improvement program, and we wanted be sure we included quality," he recalls. "We evaluated the different quality projects going on and identified hand hygiene as having the potential for improvement."
At one time, he notes, hand hygiene was considered an infection control problem. "The attitude had been, 'Let them take care of it,'" he notes. "But everyone wanted to make it a hospital problem and attack it as a team effort."
The framework for developing the steering team was created by a consulting firm that had been working with Bay Medical. "They helped us look at the items we wanted to be on the table, and developing benchmarks, targets, and so on," says Campbell.
The team included all hospital administration, other key leaders, and staff who were being groomed for leadership. "We started with observation; we conducted rounds, and when we noticed that someone was not washing their hands, we pointed it out to them," says Campbell. This involved rounding by select managers, directors, and administrators who observed and recorded, but did not report the findings beyond conversations with the individuals who were not in compliance.
Subsequently, the CEO, CFO, vice president of human resources, and other members of the leadership team joined in the rounding. As part of their rounding routine, each leader did 10 observations a week. Other individuals who were already rounding regularly became even more visible. "The idea was that people would see this was such a serious issue that even the CEO became personally involved," Campbell explains.
Poster 'children'
These efforts raised compliance to 65%-70%, but the team wanted to see even more improvement. "We got the idea for a catchy slogan," says Campbell. "A now-famous poster picturing the CEO washing his hands sported the tagline, 'Hand hygiene: So easy, even our CEO can do it!'
"They were put up all throughout the hospital — on every elevator, in every nursing unit, in the OR, in the lounges, by the front door near the elevators — everywhere," says Campbell.
They received such a positive response that additional posters were created. For example, neurosurgery featured a poster with two identical twin neurosurgeons washing their hands. The tagline read, "Hand hygiene: It's not brain surgery!"
Then, a poster was created featuring a surgeon saying, "If I can do it, you can do it!"
"If you knew him, you'd understand why this worked," says Campbell. To keep the goal in sight, only those with continual good hand hygiene could apply to be the subject of a poster. Rewarding those who demonstrated continual good hand hygiene with pocket sprayers of hand sanitizer provided a further incentive.
Observations increase
During the initial phase, recalls Campbell, about 30-50 observations were made per month. "For October, so far we have over 700 observations," he notes. "We have so many more because now it is not just infection control and the steering team, but now we are incorporating the nurses on the floors to do peer review. The manager receives their reports and sees who is compliant and who is not."
Employees who are noncompliant are treated as they would be if they had violated any other hospital policy; the first time the manager provides counseling and they are given a verbal warning, and with each subsequent violation, additional steps are taken, such as written warnings placed in their file.
When it comes down to it, says Campbell, viewing hand hygiene as a hospitalwide problem was probably the single greatest key to reaching 95% compliance. "I do a monthly presentation at the leadership meeting, and when [the consultant] handed over the project to me, I put up a poster that showed where things stood when this was an infection control problem and when it became ours," he shares. The poster said "Them vs. Us."
"I used it to show how if we come together we can accomplish great things," says Campbell.
The approach was so successful in addressing hand hygiene, he adds, that it is now being incorporated into a surge planning initiative. "Everyone is at the table — all units — because we all have specific pieces of the problem," Campbell concludes.
[For additional information, contact:
Robert Campbell, PharmD, Director of Performance Improvement, Patient Safety and Regulatory Compliance, Bay Medical Center, 615 N Bonita Avenue, Panama City, FL 32401-3623. Phone: (850) 747-6005.]
If at first you don't (totally) succeed, keep trying . . . That should be the motto of the quality leaders at Bay Medical Center in Panama City, FL. Not content with QI efforts that boosted their staff hand-washing compliance from 30%-33% to 65%-75%, they implemented additional strategies that got compliance all the way up to 95%.Subscribe Now for Access
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