Slide 1 Hand Hygiene.ppt

handhygienecompliance observation analysisthecanadianpatientsafetyinstitutewouldliketothanktheontarioministryofhealthandlongtermcarefortheireffortstowarddevelopmentoftrainingmaterials instructionsfortrainer thispresentationshouldbeusedtoteachhealthcareworkershowtoconductobservations observersmustcompletetrainingonyour4momentsforhandhygienebeforethispresentationfollowingtheteachingsession practicalsessionseitheratthepatientbedsideorbysimulation canbeorganized anexcelworkbookisprovidedtoenterandanalyzedatafromtheobservationtool theindividualresponsibleforthisactivityshouldreviewtheinstructionsforobservationtoolanalysis overview practicaltrainingforobserversonhowtoobservehandhygienecomplianceandcompleteobservationtooloverviewofauditprocessoverviewofanalysisandreportingprocess howtoobservehandhygiene directobservationusingaconsistentapproachandvalidatedtool isthemostaccuratemethodologytheobservermustfamiliarizehim herselfwiththemethodsandtoolsandmustbetrainedtoidentifyanddistinguishtheindicationsforhandhygieneoccurringatthepointofcaretheobservermustconductobservationsopenly withoutinterferingwiththeongoingwork andkeeptheidentityofthehealthcareprovidersconfidentialcomplianceshouldbedeterminedaccordingtothefourindicationsforhandhygiene keyconcepts indication opportunity healthcareactivity asuccessionoftasksduringwhichhealthcareproviders handstouchdifferenttypesofsurfaces thepatient his herbodyfluids objectsorsurfaceslocatedinthepatientenvironment eachcontactisapotentialsourceofcontaminationforhealthcareproviders handsindication thereasonwhyhandhygieneisnecessaryatagivenmoment itisjustifiedbyariskoforganismtransmissionfromonesurfacetoanother opportunity theneedtoperformhandhygiene whethertherearesingleormultipleindications handhygienemustcorrespondtoeachopportunity multipleindicationsmaycometogethertocreateasingleopportunity riskoftransmission indication opportunity handhygiene indicationandopportunity preparingtoaudit generalrecommendationsforobservation determinehowtobestidentifythetypesofhealthcareprovidersyoumaybeobserving accurateidentificationofhealthcareprovideriscriticaltoensurereliabilityofdata introduceyourselftotheobservedhealthcareprovider s andpatientsasappropriateandexplainyourrole preparingtoaudit positioningforobservation findaconvenientplacetoobservewithoutdisturbingcareactivitiesmovetofollowthehealthcareprovider butneverinterferewiththeirwork youcanalsoprovidefeedbackafterthesessionusing on the spot form takeintoaccountanyconcernsthehealthcareprovidersmayhavewithyourpresence youshouldbeasdiscreetaspossibleandinnowayinfringeontheactionsofthehealthcareprovider ifahealthcareproviderfeelsuncomfortablewithyourpresencehe shehastherighttoaskyoutoleaveandyoumustdosoifasked preparingtoaudit continued youmayobserveuptothreehealthcareproviderssimultaneously withexperience note multiplehealthcareprovidersperformingsequentialtasksquicklymayinterferewithauditaccuracy youmayincludemorehealthcareproviderssequentiallyduringoneobservationsession oneobservationsessionisfor20minutes 10minutes prolongthesessionifyougetthechancetoobserveacaresequencetoitsend observationtool howtousetheform useapenciltofillintheformandanerasertocorrect useaclipboardtoholdtheform fillintheheadoftheformbyindicatingyouridnumber observer id thedate thecurrenttimeincludingam pm starttime thenumberoftheformusedforasinglesessionusingtheformat1 2 3 etc form no seealsopoint19onreverseofobservationtool theidentityofthefacility facility id theidentityofthepatientcareunit patientcareunit howtousetheform indicateanyroomswhereadditional isolationprecautionsareinplacebyenteringinthecommentssection observeoutsidetheroom indicatethetypeofhealthcareproviderbeingobservedbyenteringthenumberthatcorrespondswiththecategorieslistedatthetopoftheform thecodingsystemisanumberfollowedbyaletter e g firstphysicianintheroomis1a ifsecondphysicianenterstheroomhe sheis1b howtousetheform continued eachcolumnisforrecordinghandhygieneopportunitiesofonehealthcareprovideronly useadditionalcolumnsforeachadditionalhealthcareproviderbeingobservedsimultaneouslyorsequentially thehealthcareprovidermayinteractwithmorethanonepatientduringthetimeyouareobserving assoonasyouobservethefirstindicationforhandhygiene indicatethecorrespondinginformationinthefirstofthenumberedopportunitysectionsinthecolumncorrespondingtothehealthcareproviderbeingobserved beforeinitialpatient patientenvironmentcontact bef pat env beforeinitialpatient patientenvironmentcontact ifthehealthcareprovidertouchesthepatient senvironmentandthentouchesthepatientorgoesdirectlytotouchthepatientafterhavingtouchedthehospitalenvironment anyothersurfacenotinthepatient senvironment oranotherpatient senvironmentifthehealthcareproviderentersthepatient senvironmentfromthehospitalenvironmentandtouchesonlythepatient senvironment doesnottouchpatient andthenleavesthepatient senvironment beforeasepticprocedure bef asp beforeasepticprocedure ifthehealthcareprovideristoperformanyofthefollowingafterhavingtouchedanyothersurfaceincludingtheconcernedpatienthimself herselfandhis herenvironment touch manipulateabodysitethatshouldbeprotectedagainstanycolonization e g woundcareincludingdressingchangeandwoundassessment manipulateaninvasivedevicethatcouldresultincolonizationofabodyareathatshouldbeprotectedagainstcolonization e g primingintravenousinfusionset insertingspikeintoopeningofivbag flushingline adjustingintravenoussite administeringmedicationthroughivport changingivtubing afterbodyfluidexposurerisk aft bfl afterbodyfluidexposurerisk ifthehealthcareproviderhasbeenengagedinacareactivityinvolvingariskofbodyfluidexposureandbeforetouchinganyothersurfaceincludingtheconcernedpatienthimself herselfandhis herenvironment e g contactwithbloodorbloodproducts emptyingurinal catheterbagandsuctioningoral nasalsecretions afterpatient patientenvironmentcontact aft pat env afterpatient patientenvironmentcontact ifthehealthcareproviderisleavingthepatientandhis herenvironmenttogoonworkinginthehospitalenvironmentorwithanotherpatientifthehealthcareproviderisleavingthepatientareaaftertouchingobjectsinthepatientenvironment withouttouchingthepatient togoonworkinginthehospitalenvironmentorwithanotherpatient ifthereismorethanoneindicationononeopportunity markthemall note ifseveralindicationsfalltogetheronthesamehandhygieneopportunity tickall example1 healthcareproviderentersroom cleanshandswithalcoholandimmediatelyperformsasepticprocedure thiswouldresultincheckingbef pat envandbef asp foreachopportunity indicatetheactionoftheprovider markwhetherthehealthcareproviderusedalcohol basedhandrub rub soapandwater wash ordidnotdohandhygiene missed ifahealthcareproviderusedsoapandwaterandthenalcohol basedhandrub orvice versa markboth gloves foreachopportunity tickifthehealthcareproviderwaswearinggloveswhentheopportunityoccurred inthisaudit wearingglovesdoesnotchangethenumberofopportunitiesforhealthcareproviderstocleantheirhands handhygienedonewithglovesonisincorrect therefore itismarkedasamissedopportunity exampleswhenglovesmaybeused whenhandlingbloodandbodyfluids mucousmembranes woundcare contactwithnon intactskinandwhereindicatedforadditionalprecautions isolation technique nails ringsandbracelets tickthecorrespondingboxesifthehealthcareproviderdoesnotmeettheguidelinesregarding correctnaillength 3 4mm inch nonailextensions artificialnailsnoringsorbracelets itisnecessarytodothisonlyonceforeachhealthcareprovider technique timingofhandhygiene timingofthedurationofhandhygienet timing thisisthedurationofhandhygieneperformedbythehealthcareproviderwhenhandhygieneoccursfor bef pat envandaft pat envopportunities useawristwatchorstopwatchtorecordduration seconds ofhandhygienebeforepatient patientenvironmentcontactandafterpatient patientenvironmentcontact begintimingwhenthehealthcareproviderstartsrubbinghis herhandswiththeproduct andstopstimingwhenhe shecompletesthemotionofrubbingtheirhandswiththeproduct note rinsingofhandswithwaterdoesnotconstituteahandwash thiswouldbecodedasamissedopportunity importantnotes eachcolumnisforrecordinghandhygieneopportunitiesofonehealthcareprovideronly useadditionalcolumnsforeachadditionalhealthcareproviderbeingobservedsimultaneouslyorsequentially thehealthcareprovidermayinteractwithmorethanonepatientduringthetimeyouareobserving note multiplehealthcareproviderssequentiallyperformingtasksquicklymaymakeitdifficulttomaintainaccurateobservationofmissedhandhygieneopportunities ifyouobservemorethanfouropportunitiesforonehealthcareprovider useanotherform numberingthemsequentiallyinthevariableform no remembertocodethehealthcareworkerinthesameway e g iftheywere2aonthefirstform theyare2aonthesecondform attheendofthesession donotforgettofillintheendtimeandchecktheform s formissingvaluesbeforehandingitin endtheobservationiftheprivacycurtainisdrawnaroundthepatient sbedorifahealthcareworkerasksyoutoleave recordanyadditionalqualitativedatainthecommentssectione g additionalprecautions isolation activitiesforobservers reviewtrainingscenarios1 4ontrainingdvdandrecordtheappropriateobservationresultsforeachscenario debriefwithotherswhenfirstlearninghowtousetheobservationtool toassistwithconsistencyandunderstandingoftheauditprocess reviewobserverscenarios5 8ontrainingdvdandrecordtheappropriateobservationresultsforeachscenario discussyourresultsasagrouporcompareyourrecordedobservationswiththeanswersforeachscenariointhehandhygienedvdanswerkey planningobservationschedule observationsuggestions eight20 minuteobservations dayatleastsevendifferentdaysofeightperiodsofobservationatdifferenttimesoftheday differentshiftsanddifferenttimeswithintheshift therefore therewillbeapproximately56observationsessionsforcalculatingtheaggregatedata feedback aggregatedata anexcelworkbooktoolhasbeenprovidedtoenterandanalyzeobservationresultsthedataentrycanbedonebytheobserveroranotherresourcemaybeassignedpredefinedreportshavebeenincludedtoanalyzedatausingfourdifferentmethodsreporttableandchartscanbepastedintopresentationstosupportfeedbackofprogresstohealthcareproviders managementandhospitalboard observationanalysistooldataentrypage methodsofanalysis datacanbeanalyzedasfollows analyzingonetypeof indication foreachhealthcareprovidercategoryatatimetoprovideforaccurateinformationtocompareovertime mostaccuratemethod combinehealthcareproviders categoriesforaspecific indication toobtainageneralizedcompliancerateforthat indication combinetheopportunitiesforeachcategoryofhealthcareprovider hcp toobtainageneralizedcompliancerateforeachhcpcategorycomparealcohol basedhandrubwithsoapandwatertoassessbehaviourchange note for2and3theinformationmaynotbecomparativeovertimeasthemixof typeofindication gatheredinopportunitiesin 2 orthecategoryofhealthcareprovider in 3 mayvaryandthereforenotprovideforaccuratecomparativerates calculatingreliablecompliancerates anoverallhandhygienecomplianceratedoesnotprovideforreliableandcomparativeratesovertimeascomplianceratesforthedifferenttypesofhealthcareproviderandfortheeachofthefourindicationsarefrequentlydifferent ifageneralizedrateistobeprovided reliabilitywillincreaseifthesamenumberisusedfortheoverallanalysis foreachcategoryofhealthcareproviderandforthenumberofobservationsofeachindication reports1a d preferredmethod calculatingreliablehandhygienecompliancerates complianceratesaretobecalculatedseparatelyforeachtypeofindicationandeachhealthcareprovidercategory e g nursesbef pat env70percent physiciansaft pat env70percent respiratorytherapistaft bfl 85percent complianceratesmustbereportedby eachhandhygieneindicationeachhealthcareprovider hcp category timeshandhygienewasperformedforaspecificindication specifichcpcategoryx100 observedhandhygieneindicationsforspecificindication specifichcpcategory thenumberofobservationstomaketheinformationmeaningfulwilldependonunitsize patientpopulationandhospitalsize breakdownofthecomplianceratesbyindicationandhealthcareprovidercategoryprovidesdatafordevelopingtargetedandappropriateinterventionstoimprovecompliance overallgeneralizedcomplianceratecombininghealthcareprovidersand orcombiningtypesofindicationswillnotprovideforreliability report1a sample calculation timeshandhygienewasperformedforbef pat envbyspecifichcpcategoryx100 compliance observedhandhygieneindicationsforbef pat envbyspecifichcpcategory report1b sample calculation timeshandhygienewasperformedforbef aspbyspecifichcpcategoryx100 compliance observedhandhygieneindicationsforbef aspbyspecifichcpcategory report1c sample calculation timeshandhygienewasperformedforaft bflbyspecifichcpcategoryx100 compliance observedhandhygieneindicationsforaft bflbyspecifichcpcategory report1d sample calculation timeshandhygienewasperformedforaft pat envbyspecifichcpcategoryx100 compliance observedhandhygieneindicationsforaft pat envbyspecifichcpcategory report2 sample calculation timeshandhygienewasperformedforaspecificindicationbyallcategoriesofhcpx100 compliance observedhandhygieneindicationsforaspecificindicationbyallcategoriesofhcp report3 sample calculation opportunitieshandhygieneperformedbyspecifichcpcategoryx100 compliancetotal observedhandhygieneopportunitiesforaspecifichcpcategory report4 sample calculation ofopportunitieshandrubwasusedtocleanhandsx100 rubtotalnumberofopportunitieshandhygienewasobserved ofopportunitiessoapandwaterwasusedtocleanhandsx100 washtotalnumberofopportunitieshandhygienewasobserved ofopportunitieshandrubandsoapandwaterwerebothusedtocleanhandsx100 bothtotalnumberofopportunitieshandhygienewasobserved instructionsfortrainer thispresentationshouldbeusedtoteachhealthcareworkershowtoconductobservations observersmustcompletetrainingonyour4momentsforhandhygienebeforethispresentationfollowingtheteachingsession practicalsessionseitheratthepatientbedsideorbysimulation canbeorganized anexcelworkbookisprovidedtoenterandanalyzedatafromtheobservationtool theindividualresponsibleforthisactivityshouldreviewtheinstructionsforobservationtoolanalysis overview practicaltrainingforobserversonhowtoobservehandhygienecomplianceandcompleteobservationtooloverviewofauditprocessoverviewofanalysisandreportingprocess howtoobservehandhygiene directobservationusingaconsistentapproachandvalidatedtool isthemostaccuratemethodologytheobservermustfamiliarizehim herselfwiththemethodsandtoolsandmustbetrainedtoidentifyanddistinguishtheindicationsforhandhygieneoccurringatthepointofcaretheobservermustconductobservationsopenly withoutinterferingwiththeongoingwork andkeeptheidentityofthehealthcareprovidersconfidentialcomplianceshouldbedeterminedaccordingtothefourindicationsforhandhygiene keyconcepts indication opportunity healthcareactivity asuccessionoftasksduringwhichhealthcareproviders handstouchdifferenttypesofsurfaces thepatient his herbodyfluids objectsorsurfaceslocatedinthepatientenvironment eachcontactisapotentialsourceofcontaminationforhealthcareproviders handsindication thereasonwhyhandhygieneisnecessaryatagivenmoment itisjustifiedbyariskoforganismtransmissionfromonesurfacetoanother opportunity theneedtoperformhandhygiene whethertherearesingleormultipleindications handhygienemustcorrespondtoeachopportunity multipleindicationsmaycometogethertocreateasingleopportunity riskoftransmission indication opportunity handhygiene indicationandopportunity preparingtoaudit generalrecommendationsforobservation determinehowtobestidentifythetypesofhealthcareprovidersyoumaybeobserving accurateidentificationofhealthcareprovideriscriticaltoensurereliabilityofdata introduceyourselftotheobservedhealthcareprovider s andpatientsasappropriateandexplainyourrole preparingtoaudit positioningforobservation findaconvenientplacetoobservewithoutdisturbingcareactivitiesmovetofollowthehealthcareprovider butneverinterferewiththeirwork youcanalsoprovidefeedbackafterthesessionusing on the spot form takeintoaccountanyconcernsthehealthcareprovidersmayhavewithyourpresence youshouldbeasdiscreetaspossibleandinnowayinfringeontheactionsofthehealthcareprovider ifahealthcareproviderfeelsuncomfortablewithyourpresencehe shehastherighttoaskyoutoleaveandyoumustdosoifasked preparingtoaudit continued youmayobserveuptothreehealthcareproviderssimultaneously withexperience note multiplehealthcareprovidersperformingsequentialtasksquicklymayinterferewithauditaccuracy youmayincludemorehealthcareproviderssequentiallyduringoneobservationsession oneobservationsessionisfor20minutes 10minutes prolongthesessionifyougetthechancetoobserveacaresequencetoitsend observationtool howtousetheform useapenciltofillintheformandanerasertocorrect useaclipboardtoholdtheform fillintheheadoftheformbyindicatingyouridnumber observer id thedate thecurrenttimeincludingam pm starttime thenumberoftheformusedforasinglesessionusingtheformat1 2 3 etc form no seealsopoint19onreverseofobservationtool theidentityofthefacility facility id theidentityofthepatientcareunit patientcareunit howtousetheform indicateanyroomswhereadditional isolationprecautionsareinplacebyenteringinthecommentssection observeoutsidetheroom indicatethetypeofhealthcareproviderbeingobservedbyenteringthenumberthatcorrespondswiththecategorieslistedatthetopoftheform thecodingsystemisanumberfollowedbyaletter e g firstphysicianintheroomis1a ifsecondphysicianenterstheroomhe sheis1b howtousetheform continued eachcolumnisforrecordinghandhygieneopportunitiesofonehealthcareprovideronly useadditionalcolumnsforeachadditionalhealthcareproviderbeingobservedsimultaneouslyorsequentially thehealthcareprovidermayinteractwithmorethanonepatientduringthetimeyouareobserving assoonasyouobservethefirstindicationforhandhygiene indicatethecorrespondinginformationinthefirstofthenumberedopportunitysectionsinthecolumncorrespondingtothehealthcareproviderbeingobserved beforeinitialpatient patientenvironmentcontact bef pat env beforeinitialpatient patientenvironmentcontact ifthehealthcareprovidertouchesthepatient senvironmentandthentouchesthepatientorgoesdirectlytotouchthepatientafterhavingtouchedthehospitalenvironment anyothersurfacenotinthepatient senvironment oranotherpatient senvironmentifthehealthcareproviderentersthepatient senvironmentfromthehospitalenvironmentandtouchesonlythepatient senvir