I have a cameo appearance on an NPR report tonight by Richard Knox on hospital acquired infections and again discussed the issue of hand hygiene. You can listen here.
We have made some, but not satisfactory, progress on the hand hygiene issue at our hospital. In keeping with our emphasis on transparency, you can look here and use the pull down menu of "alphabetical listing of topics" to view the "hand hygiene" figures through the spring, about which I commented in April.
We keep adding ideas and programs in this arena, for visitors as well as providers, using virtually every idea we can scour from other hospitals in the country. But no one has discovered the silver bullet on this yet. If you hear of any good ideas, please submit them. Meanwhile, I am anxiously awaiting the next period's figures to see if we have improved.
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As a second year medical student currently doing (and loving) my clinical skills class at BIDMC, I'd be curious to know how the component of the hand hygiene campaign encouraging patients to ask whether their caregivers have washed their hands is working out. Do many patients actually ask? How well do doctors and other staff members respond?
Hello Paul and readers,
As a writer for the Pittsburgh Regional Health Initiative, I was in an unique position to watch as Toyota-based improvements were applied at the Pittsburgh VA hospital with astounding results: an 85% decrease in MRSA on the subject unit.
I cover the topic at length in the upcoming book, "The Pittsburgh Way to Efficient Healthcare: Improving Patient Care Using Toyota Based Methods," which will be out December 1. For a sneak peek at the book, and an annotated Table of Contents, visit www.naidagrunden.com.
Miya,
It's embarrassing to say so, but during my 7 BIDMC admissions this year, with all the days and nights I spent looking at those signs in my rooms, encouraging me to ask staff, I never did. Even with all my opinions about patient empowerment, I somehow felt it really wasn't appropriate for me to ask that. (That's REALLY weird, for me. But I bet it has something to do with implying that they're not doing their job, even though the signs proclaim "We don't mind - really!")
So, Paul, perhaps there's an angle here worth pursuing - further empowering patients to speak up. Or, in my case, it might work better to empower my *mom*, or other family members. (Like, have a simple handout flyer for visitors.)
I wonder what it would cost to license the image of Jiminy Cricket from Disney, as the conscience of the program...
Paul, check out www.everythinghealth.net for my reference to your good work with reducing nosocomial infections. We shouldn't be afraid to talk about this and you are leading the way. Best TB
Thanks, Toni!
Paul, I heard the report last night-- it was a good piece, if a little depressing overall. It was funny-- reading your blog all this time it felt like a 'friend' was on the radio!
I like Patient Dave's idea of empowering friends and family members of patients, they're often in a better place to notice things. (And then, of course, the staff has to prove they don't mind by taking the reminders in good faith.)
Thanks, Bridgett. The staff is very good about this. As Dave notes, it is usually the patients who are reluctant. Will pursue the family idea.
...and it is even more weird for me to hear me on the radio! Dick Knox is a superb reporter, though, as we had a great talk about lots of issues.
As a nurse and a recent patient at BIDMC, I was very concious of this hand-washing effort and when anyone came into my room, I paid attention to the fact that they used the hand sanitizing wash and if they didn't (which only happened twice), I mentioned it kindly. I do feel that there is an intimidation factor though for most patients and that more patient and family education would be a positive approach.
In all honesty, I do not know if I would be able to look at my doctors and the nurses and other care takers and question why they did not wash their hands... I feel like they would think I do not trust their care of me. Most probably they would not, but still, I feel that way. Maybe my family can ask them...
Coincidentally, I blogged this subject... http://healthsass.blogspot.com and observed that in my hosp stays, I never once had a doctor enter my room, wash in my bathroom and then touch me. There is a new org now called www.hospitalinfection.org that has useful info for the public.
I did once ask a nurse why she was doing my IV with no gloves. She said it was the best way for her to find a vein on me--at least it was a conversation!
Maybe give patients or visitors a sticker to put on their shirt or pillow. It would be a visual reminder and sort of a "badge of empowerment" to the patient... at least a topic for conversation.
Just need to think of a catchy slogan...
I think I'm fairly empowered and yet I still have trouble asking my doctor to wash their hands in my presence.
I'd love it if more hospitals published statistics about hand hygiene or acquired infections or something to help bring it to the attention of healthcare providers.
To me one of the problems is that if I point it out I may be seen as a complainer and it doesn't necessarily change someone's behavior. I'd like to have some way to leave a lasting impression.
A slogan? I guess having a sticker on your gown saying
"Come clean" might elicit admissions from your doctor you might not want.
Very good!!!
Inspired by restaurant hand washing and the idea that people are more likely to feel badly touching someone else's food with dirty hands:
Would it help to put a bowl of apples beside every door? Instruct the doctors that they must give each patient an apple, and that the apples need to be washed. Might as well wash your hands if you're already washing the apple. You know what they say, an apple a day...
Maybe a more effective idea: put sticky goop on all door handles. Every time they open a door, Drs. will have a sticky reminder to wash.
I often wonder how many healthcare workers would test positive for MRSA? Did you ever test your staff?
As an RN presently employed at BIDMC, I religiously do the hand hygiene thing, but I've also wondered if whoever is "watching" the floor hh (probably observing in the hallway as direct care personnel go in & out of rooms, use of hallway applicators) is also "watching" the use of hand hygien applicators in each room. I often use the ones in patient rooms, not always the hallway gizmos... that may not get counted.
When it comes to handwashing, there is still a disconnect between observed vs. self-reported behavior. While not conducted in hospitals, a recent observational study sponsored by the American Society for Microbiology (ASM) and The Soap and Detergent Association (SDA), slightly over three-quarters of men and women (77 percent) washed their hands in public restrooms — a 6 percent decline from a similar study conducted in 2005. Yet in a separate telephone survey, 92 percent of adults say they wash their hands in public restrooms.
FORT WORTH � A bloody brawl erupted outside a tavern after one customer thought another failed to wash his hands after using the bathroom, police said. One man was hospitalized with stab wounds. Another was arrested on suspicion of aggravated assault with a deadly weapon after the fight at the Tumbleweeds Sports Bar.
A crime of passion...for hand hygiene. So, where's the passion in health care?
Anonymous
I heard that one. Great job!
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