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KH may use tech to track hand washing

Posted: July 31, 2012 6:16 p.m.
Updated: August 1, 2012 5:00 a.m.

Washing your hands. It sounds simple, almost trivial to talk about. However, ever since Joseph Lister -- working off the theories of Ignaz Semmelweis and Oliver Wendell Holmes Sr. -- pioneered antiseptic surgery, it’s been an important component to keeping patients healthy and alive in hospitals around the world. So important that the very act of hand washing has become something to be tracked at KershawHealth.

The question is how to do it.

“Hand hygiene is very hard to monitor,” KershawHealth Infection Prevention and Control Director Paula Guild told member of the KershawHealth Board of Trustees at its July 23 meeting. “There are only a few opportunities to observe it.”

In fact, Guild said, people’s behavior changes when they know you are watching them. When someone knows they’re being watched, she said, they may not just wash their hands, but wash them more thoroughly that they otherwise might. On top of that, different observers -- being human -- will observe things differently. What one monitor says is correct hand washing technique might be seen as lacking by someone else.

So, what to do?

Guild said KershawHealth is looking into new electronic monitoring systems that are coming on the market.

One type she said they looked at would use employee badges that would vibrate when they had taken an action that required hand washing. Guild deemed that method too costly. Another system uses alcohol/soap sensors to monitor groups of employees.

“It uses a fancy algorithm to look at how many times it is activated versus an hourly census for hand hygiene,” Guild said, adding that it would compare the number of occurrences versus missed opportunities.

In response to a trustee’s question, Guild also said the hospital may want to invest in installing antimicrobial copper or silver impregnated devices.

“They are natural antibacterials,” she said.

Guild’s presentation is one she makes annually to trustees, covering the gamut of what KershawHealth does to keep the rate of infections down. She began the July 23 presentation by listing out the healthcare system’s priorities during the current fiscal year, which ends Sept. 30. They include:

• preventing catheter associated urinary tract infections (CAUTI);

• preventing central line association bloodstream infections (CLABSI);

• preventing surgical site infections (SSI);

• increasing hand hygiene; and

• reaching national patient safety goals, including those dealing with central line insertion practices and patient/family education on surgical site infection prevention and multi-drug resistant organisms.

Guild said monitoring of these priorities includes reviewing microbiology cultures, admitting diagnoses, chief complaints for emergency department and Elgin Urgent Care patients, death charts, phone reports, rounds and other lab reports.

One of the most critical infection prevention and control activities is outbreak management, Guild said.

“We have to get on those as quickly as possible so infections don’t spread,” she said, noting that KershawHealth has successfully dealt with such events in recent years.

Other prevention and control activities have included education to healthcare workers on guideline changes and updates, observing behavioral practices, coordinating organizational changes with staff and vendors, surveillance of data collection and analysis and even having Guild involved in construction-related meetings.

A problem comes up in terms of definitions, however. The U.S. Centers for Disease Control (CDC) and Prevention’s National Health Safety Network uses one set of definitions to track infection rates, while the Centers for Medicare & Medicaid Services (CMS) follows a “coding” system based on physician documentation. Measurements depend on who’s conducting the measurements, Guild said.

There are also different denominators -- is an infection rate dependant on the number of patients, number of patient days or number of procedures? Guild said one method is called a standardized infection ratio taking into account the number of observed infections compared to the number of expected infections.

In the meantime, Guild said KershawHealth’s annual hand hygiene rates have risen during the last five years, far surpassing the national average rate of compliance. In 2007, KershawHealth’s “decontamination - successful” rate for hand washing stood at only 60.96 percent, a bit below the 65 percent national rate. Now, as of 2011, KershawHealth’s rate is at 95.27 percent.

With that, the rates of certain types of infections have gone down.

For example, the hospital’s number of CAUTI events has dropped from 46 in 2009 to only nine so far in 2012.

“We’re very happy with this. This has been a priority,” Guild said.

She said KershawHealth has worked hard to determine when it is and is not appropriate to use foley catheters, and changed out such products from a silicone type to latex.

“We have worked to have the staff care for and use catheters appropriate,” Guild said.

As a result, urinary catheter utilization has decreased since 2008, generating additional cost savings to the healthcare system, she said.

Based on data Guild presented, KershawHealth’s SSI rates are low, in some instances only accounting for one or two cases.

“The goal is always zero, though,” Guild said.

Finally, Guild touched on central line insertion practices. The goal is to make sure that for each one performed, nurses have completed a checklist that goes with the procedure. KershawHealth has tracked such practices on a quarterly basis. In the first quarter of 2010, only 65 central lines were inserted, but only about 10 percent of them while completing the checklist. Nurses went through the checklist more often, peaking in the third quarter of 2011 at 150 central line insertions with approximately 70 percent of them while completing the checklist. Both the number of procedures and checklist completion declined in the first two quarters of this year, dropping back to approximately 60 percent and 55 percent, respectively.

“A documentation change wasn’t communicated to all the nurses,” Guild said.

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