Research Findings

Insight Gatherings
Sophie Clyne
Hand Hygiene
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Sources
Larson (2013)
Practically Speaking (2011)
Staff Sessions at MSJ and SPH
Leadership Discussions
Site Visits
Web Search
Lit Review
Hand Hygiene Project: Best Practices (2010)
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Memorial Sloan-Kettering Cancer Center in New York
City, Larson, 2013
Recognized that publication of results wasnt enough. They worked in small teams with QI,
IPAC and unit staff. The teams identified barriers and set their own hand hygiene performance
goals. The teams made common work flow diagrams for hand hygiene indications. They also
trained up staff members for peer audits- results were then submitted to IPAC dept. Compliance
increased from 60-70% to 97% and continues to be sustained.
Essential to change= behavioural perceptions. First staff need to understand their current state-
providing meaningful and motivational feedback to front line staff. The feedback must be provided
and delivered in a way that is readily accessible so that staff members are able to interpret and
act on the results. Staff must agree that change is needed and be willing to modify their
behaviour.
Positive deviants: frontline staff already recognized as having consistent and effective hand hygiene
and serving as role models. Positive deviance studying has been used successfully for such
problems as weight loss and adherence to hand hygiene.
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Positive Deviants
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Practically Speaking
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Successful Programs
Took a long time!
Fully engaged frontline, administrative, and clinical leadership
Respectful and non punitive
Transferred ownership to clinicians- change in culture
Actionable feedback model- timely, non punitive, individualized, customizable
6 key elements of behavior change: organizational learning, support, resources,
accountability, communication and collaborative, frontline engagement, locally focused
implementation, feedback and reinforcement
Direct obs replaced with automated monitoring
Cease using enforcement
Develop understanding of what motivates behavior change and the patience to plan long
term
Engage front line to find out what they find meaningful and how to develop long term
strategies
Holding each other to account, and just in time coaching (quality coaches/champions on the
units)

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Insights- Cedars-Sinai, Lutheran Medical Centre, Froedtert Hospital,
Johns Hopkins, Memorial Hermann, Trinity Health, Virtua, Wake Forest
Food service staff carrying trays and not washing hands, touching patient environment
Privacy curtains were colonised in some patient rooms at Cedars-Sinai
Lab coats transferring bugs- this was tackled by having lab coats outside every room
Bundle tasks so that there arent as many trips into the room
Used six sigma and lean to look at processes such as arterial blood gas draw
Examining work flow can help limit the numbers of times we are asking car providers to
wash their hands
4 out of 8 used technology. Healthcare personnel wear infra red badges. A light on the
dispenser records them washing their hands. Johns Hopkins is testing this technology in its
simulation centre.
WFUBMC use an electronic method to monitor and increase compliance- infrared trackers
on the sinks and sanitizers track usage. They have had no HAI in last 5-6 months
Technology is a way to get to 100%
Main causes of failure to clean hands: ineffective placement of sinks or dispensors, hand
hygiene scores not reported, lack of accountability and coaching, safety culture that does not
stress hand hygiene, hands full, ineffective education, wearing gloves inappropriately,
forgetting, distractions.
Work flow! Match dispensers so that they fit work flow

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Patient and Family involvement
Hand hygiene score cards that
patients and families that were on
the unit longer than 24 hours and
not in crisis- asked to score the
staff on their hand hygiene.
Involving patients and families-
please remind me!
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Analogous industries/Fresh
Eyes Perspective
Airline
Airmiles rewards card- more you use, more positive. If there were infrared tracking,
could use to highlight positive deviance?
Supermarket
Force function- cant take trolley past threshold. Cant enter/leave without washing
hands?
Travel Planning
Mapping out the most efficient route for flying.
Formula 1
Zoo
Theatre

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Staff Feedback Session
Empty Sanitizers! They need filling up
In emergency situations- struggle to clean hands.
What works: reporting comparison of data across units
and post this. Include individual level data!
USE TECHNOLOGY! Dont rely on manual audits.



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Site Visits; VCH
Comparators across units
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Site Visits; VCH
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Site Visits; ICU
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BC cancer
Branding
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BRAINSTORMING
Random Associations
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BRAINSTORMING
Stepping Stones- connections
Outrageous
Issue at work
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BRAINSTORMING
Seven Ways