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A1786
October 16, 2007 2:00 PM - 4:00 PM Room Hall D, Area O, |
| A New Approach To Improve Care Providers' Hand Hygiene To Combat Hospital-Acquired Infections* |
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Igal Nevo, M.D., Stephen R. Scheinman, M.D., F.A.C.P., F.C.C.P., Maureen Fitzpatrick, M.S.N., A.R.N.P., Abbe Bendell, R.N., M.B.A., David J. Birnbach, M.D., M.P.H. Anesthesiology, Center for Patient Safety, University of Miami-Jackson Memorial Hospital, Miami, Florida |
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Introduction: Hospital-Acquired Infections (HAI) are a critical problem impacting patients, healthcare providers and organizations. It is estimated that HAI affect 2 million inpatients and cause 90,000 deaths in the USA annually. Economically, an additional $57 to $90 billion in healthcare costs result yearly. [1,2] Multiple researchers and healthcare organizations, including the WHO, have estimated as many as 5% of inpatients suffer from HAI worldwide. Two main causes of HAI are Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterobacter (VRE). Once only hospital 'residents,' these infectious agents have recently penetrated the general community. Researchers have identified lack of hand hygiene as the single most significant cause of HAI. To date, most methods to overcome care providers' poor hand hygiene practices have met with only sporadic success. Those programs employed lectures and/or enforcing strict aseptic rules. We postulate that HAI is related to care providers' attitude and old habits rather than lack of formal knowledge or education. This is further supported by results of a study showing that only 43.4%-53.8% (n=52) of physicians and nurses observed some level of hand hygiene; only one person practiced hand hygiene, as required, both before and after patient contact. [3] To overcome these habits, we have implemented a new online Hand Hygiene program. The main feature is a realistic video, which we produced to show how poor hand hygiene practices increase the risk of HAI, causing devastating results for patients. Slide presentation of theoretical material complements the online program. Methods: With local IRB approval, the program's efficacy is being evaluated in the trauma ICU (TICU). The study consists of an anonymous online pre- and post-program tests; periodic MRSA and VRE infection rates and antibiotics utilization, which are compared to pre-implementation baseline values. Additionally, participants complete an anonymous program evaluation questionnaire, using a five-scale rating. All personnel that have patient care responsibilities including physicians, nurses, allied medical personnel, and students participate in the study. Alcohol-based gel rub is dispensed and departmental utilization rate is being monitored anonymously. Results: Twenty seven employees (n=27) completed the study in the first 2 weeks. Preliminary pre- and post-test results show statistically significant difference (p<0.01). Using the 5 scale (5=very high), program satisfaction ratings are: 4.26-relevance; 4.2-easy program; 4.13-realistic video; 4.4-video supports training; 4.06-course recommended; 3.4-length of program. Discussion: The results indicate that the program has positive impact on individuals. Data collection continues and more complete results will be available at the ASA, however, the full impact is not expected before 6-10 months from implementation. This program will now be expanded to all other hospital departments. References: 1. Research Briefs (2005) Hospital acquired infections in Pennsylvania. PHC4 Report (5) July, 2005 2. Bureke JP (2003): Infection Control – A problem for patient safety. NEJM 348 (7) 651-656 3. Scheinman S.R, et. Al (2007): Quantitative Assessment of hospital design solutions to reduce human error (paper in preparation for submission) *Supported in part by US DoL Grant EA 15417-06-60. Anesthesiology 2007; 107: A1786 |