How Huddles How Huddles Improved Hand Improved Hand

Hygiene and Hygiene and Reduced VREReduced VRE

A reflection on our journeyA reflection on our journey

OverviewOverview

• Identification of the problem: Identification of the problem: – Rising VRE ratesRising VRE rates

• Use of high reliability concepts for Use of high reliability concepts for changechange

• End results End results

Commercial Interest Commercial Interest Disclosure:Disclosure:

• Colleen ZidikColleen Zidik• How Huddles Improved Hand How Huddles Improved Hand

Hygiene and Reduced VREHygiene and Reduced VRE• The presenter today has no The presenter today has no

commercial interests to disclose.commercial interests to disclose.

Objectives:Objectives:

• Importance of evaluating small tests Importance of evaluating small tests of changeof change

• Importance of inter- and intra- Importance of inter- and intra- professional involvement and team professional involvement and team collaboration for sustainable resultscollaboration for sustainable results

Unit's Nosocomial VRE Rates: Cases Per 1,000 Patient Days

11.7

3

0

9

13.8

0

2.8

9

0

5

10

15

Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08

Curtains

Action Team

Unit's Hand Hygiene Compliance

0

20

40

60

80

100

Dec-07 Jan-08 Feb-08 Mar-08 Apr-08

Goal is 90%!

What Happened?What Happened?

• High Reliability Concepts (Roger Resar)High Reliability Concepts (Roger Resar)– Process versus outcome Process versus outcome – StandardizationStandardization– Identification of defectsIdentification of defects– Daily Huddle (Mon - Fri)Daily Huddle (Mon - Fri)

• What went wrong?What went wrong?• What went right?What went right?• What would you change?What would you change?

Action Team Brainstorming Action Team Brainstorming Ideas:Ideas:

What are the defects?What are the defects?• I can’t find the PurellI can’t find the Purell• If I have to change gloves in the room, new If I have to change gloves in the room, new

ones aren’t availableones aren’t available• I have to walk all around the unit to find a I have to walk all around the unit to find a

laundry basketlaundry basket• How is the BP cuff cleaned between How is the BP cuff cleaned between

patients?patients?• I didn’t know the impact HCAI had on I didn’t know the impact HCAI had on

PatientsPatients• These yellow gowns do not provide enough These yellow gowns do not provide enough

protectionprotection

Measures ImplementedMeasures Implemented• Glove box holders in each roomGlove box holders in each room

– Reduced # glove boxes stocked on cart, Reduced # glove boxes stocked on cart, making Purell holders visible & accessiblemaking Purell holders visible & accessible

• Laundry Hampers in each room Laundry Hampers in each room – Initial trial used trash cans designated for Initial trial used trash cans designated for

laundrylaundry

• BP cuffs & Stethoscopes for each Patient BP cuffs & Stethoscopes for each Patient BedBed– Cleaned by UA after dischargeCleaned by UA after discharge

• Infection Control In-servicesInfection Control In-services• New Precaution Gowns New Precaution Gowns

YesYes No No Why?Why?

Are Purell dispensers visible?

Does each patient bed have BP cuff & Stethoscope in place?

Are people removing protective equipment within the patient room?

Are people using Purell at the door prior to entry & then after removing PPE?

Are “laundry” trashcans overflowing with dirty laundry?

Are 3 staff members able to identify when they need to wash hands?(Answer: At the doorway to the patient room before entering patient room, and after removing PPE )

Ask 3-5 staff members the following questions regarding the Pilot Project:What went wrong?What went right?What would you change?

Huddles:Huddles:

May:May:Problem: MDs were not using Purell before entering roomProblem: MDs were not using Purell before entering room

Solution: Reminder cards on outside of door to use PurellSolution: Reminder cards on outside of door to use Purell

June:June:Problem: RNs were not using Purell upon exiting roomProblem: RNs were not using Purell upon exiting room

Solution: Purell on the inside of the door in patient roomSolution: Purell on the inside of the door in patient room

July:July:Problem: Food trays brought from room to nurses’ deskProblem: Food trays brought from room to nurses’ desk

Solution: Dirty tray holder on unitSolution: Dirty tray holder on unit

6B Hand Hygiene Rates

0

20

40

60

80

100

Mar-08 Apr-08 May-08 Jun-08 Jul-08

Identified need for Purell As you exit the room

HCAI In-services began

6B VRE Rates per 1,000 Patient Days

2.8

9

2.9 2.92.8

0

2

4

6

8

10

Mar-08 Apr-08 May-08 Jun-08 Jul-08

HCAI In-Services began

Huddles occurred May-July

Was This Initiative Was This Initiative Sustainable?Sustainable?

Hand HygieneHand Hygiene• FY2008 FY2008 84% 84% • FY2009 FY2009 88% 88% • FYTD (Feb) 2010 FYTD (Feb) 2010 94%94%

VRE Rates/1,000 patient daysVRE Rates/1,000 patient days• FY2008 FY2008 4.74.7• FY2009 FY2009 2.22.2• FYTD (as of Feb) 2010 FYTD (as of Feb) 2010 1.91.9

Questions?Questions?

• Impact on small tests of change?Impact on small tests of change?• Impact of inter- and intra- Impact of inter- and intra-

professional collaboration?professional collaboration?

Original Action Team Original Action Team MembersMembers

• Rebecca Spitz, RN NICRebecca Spitz, RN NIC• Carolyn Clark, UCCarolyn Clark, UC• Stephanie Carroll, PAStephanie Carroll, PA• Rob Schlossman, MDRob Schlossman, MD• Candy Hsieh, RN ICCandy Hsieh, RN IC• Susan O’Rourke, RN ICSusan O’Rourke, RN IC• Rose Villarreal, PA ICRose Villarreal, PA IC• Marsha Milone, RN Marsha Milone, RN

ANMANM• Jeanne Barton, Dir. Jeanne Barton, Dir.

Operations Operations ManagementManagement

• Luis Soto, Asst. Dir. Luis Soto, Asst. Dir. Environmental ServicesEnvironmental Services

• Jeannie Keith, RN NMJeannie Keith, RN NM• Colleen Zidik, RN QPMColleen Zidik, RN QPM

• Tamara Devlin, Ops Tamara Devlin, Ops SupSup

• Andy Madden, Dir. Andy Madden, Dir. Materials Materials ManagementManagement

• Karen Purdy-Reilly, Karen Purdy-Reilly, Food ServicesFood Services

• Maggie Bikowski, ICMaggie Bikowski, IC• Miriam Perez, ESD Miriam Perez, ESD

SupervisorSupervisor

ObjectivesObjectives

• Importance of evaluating small tests Importance of evaluating small tests of changeof change

• Importance of inter- and intra- Importance of inter- and intra- professional involvement and team professional involvement and team collaboration for sustainable resultscollaboration for sustainable results