CALIFORNIA: Simple protocol helped improve surgical ICU handwashing compliance
Posted: February 4th, 2011 - 7:30am
Source: Internal Medicine News
SAN DIEGO – Adding a simple question to the daily ICU checklist about handwashing before touching patients significantly improved handwashing compliance and was associated with a decreased rate of central line–associated bloodstream infections in a surgical intensive care unit over the course of 6 months.
"If you look at how people address hand hygiene compliance overall, most of the time it’s with fairly elaborate and expensive educational and marketing campaigns," Dr. Jeremy Pamplin said in an interview after the study was presented during a poster session at the annual congress of the Society of Critical Care Medicine. "Inevitably, you improve hand hygiene compliance for a while. Then the campaign goes away and you start to have fading of the compliance."
As part of a process improvement project, Dr. Pamplin, medical codirector of the 20-bed surgical/trauma ICU at Brooke Army Medical Center, Fort Sam Houston, Tex., and his associates added the following question to their daily ICU checklist: "Has anyone seen anyone else touch the patient without washing their hands in the past 24 hours?" The question was asked during multidisciplinary ICU rounds for every patient, and only "yes" or "no" answers were allowed.
If respondents answered "yes," they were asked to provide the name of the offender, which was recorded. Compliance was measured by a third-party observer and was defined as washing hands or using hand sanitizer prior to touching a patient or the patient’s immediate surroundings.
Dr. Pamplin and his associates collected data for 3 months before and 3 months after this question was added to the ICU checklist. Over that period, the rate of handwashing compliance significantly increased from 69% to 89%, while the rate of central line–associated bloodstream infections decreased from 13.7/1,000 central line days to 2.7/1,000 central line days, an improvement that did not reach statistical significance.
"Before we introduced this question to our checklist, it was very rare for a provider to tell another provider, ‘Hey, I didn’t see you wash your hands,’ " Dr. Pamplin said. "After we introduced this question, people started doing it because we gave leadership and emphasis to it."
This resulted in a change of culture, he continued, "so if nurses, residents, or technicians saw someone walk into the room without washing their hands, they would stop them and say, ‘Hang on a second; you didn’t wash your hands.’ Everyone knows that hand hygiene is an important part of infection control. The hard part is remembering to do it. It’s a rare circumstance that someone gets upset by another health care provider who says, ‘Hey, you forgot to wash your hands.’ Because we have talked about hand hygiene compliance on rounds as a team, it has elevated that component of infection control so that everyone recognizes it as being important."