How Huddles Improved
Hand Hygiene and
Reduced VRE
A reflection on our journey
Overview
• Identification of the problem:
– Rising VRE rates
• Use of high reliability concepts for change
• End results
Commercial Interest Disclosure:
• Colleen Zidik
• How Huddles Improved Hand Hygiene and
Reduced VRE
• The presenter today has no commercial interests
to disclose.
Objectives:
• Importance of evaluating small tests of change
• Importance of inter- and intra- professional
involvement and team collaboration for
sustainable results
Unit's Nosocomial VRE Rates:
Cases Per 1,000 Patient Days
Curtains
15
13.8
Action
Team
11.7
10
9
9
5
3
0
2.8
0
0
Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08
Unit's Hand Hygiene Compliance
100
Goal is 90%!
80
60
40
20
0
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08
What Happened?
• High Reliability Concepts (Roger Resar)
– Process versus outcome
– Standardization
– Identification of defects
– Daily Huddle (Mon - Fri)
• What went wrong?
• What went right?
• What would you change?
Action Team Brainstorming Ideas:
What are the defects?
• I can’t find the Purell
• If I have to change gloves in the room, new ones
aren’t available
• I have to walk all around the unit to find a laundry
basket
• How is the BP cuff cleaned between patients?
• I didn’t know the impact HCAI had on Patients
• These yellow gowns do not provide enough
protection
Measures Implemented
• Glove box holders in each room
– Reduced # glove boxes stocked on cart, making Purell
holders visible & accessible
• Laundry Hampers in each room
– Initial trial used trash cans designated for laundry
• BP cuffs & Stethoscopes for each Patient Bed
– Cleaned by UA after discharge
• Infection Control In-services
• New Precaution Gowns
Yes
No
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:
May:
Problem: MDs were not using Purell before entering room
Solution: Reminder cards on outside of door to use Purell
June:
Problem: RNs were not using Purell upon exiting room
Solution: Purell on the inside of the door in patient room
July:
Problem: Food trays brought from room to nurses’ desk
Solution: Dirty tray holder on unit
6B Hand Hygiene Rates
HCAI In-services
began
Identified need for Purell
As you exit the room
100
80
60
40
20
0
Mar-08
Apr-08
May-08
Jun-08
Jul-08
6B VRE Rates per 1,000 Patient Days
10
HCAI In-Services
began
9
Huddles occurred May-July
8
6
2.9
4
2
2.8
2.9
Jun-08
Jul-08
2.8
0
Mar-08
Apr-08
May-08
Was This Initiative Sustainable?
Hand Hygiene
• FY2008 84%
• FY2009
88%
• FYTD (Feb) 2010
94%
VRE Rates/1,000 patient days
• FY2008 4.7
• FY2009 2.2
• FYTD (as of Feb) 2010 1.9
Questions?
• Impact on small tests of change?
• Impact of inter- and intra- professional
collaboration?
Original Action Team Members
•
•
•
•
•
•
•
•
•
Rebecca Spitz, RN NIC
Carolyn Clark, UC
Stephanie Carroll, PA
Rob Schlossman, MD
Candy Hsieh, RN IC
Susan O’Rourke, RN IC
Rose Villarreal, PA IC
Marsha Milone, RN ANM
Jeanne Barton, Dir.
Operations Management
• Luis Soto, Asst. Dir.
Environmental Services
• Jeannie Keith, RN NM
• Colleen Zidik, RN QPM
• Tamara Devlin, Ops Sup
• Andy Madden, Dir. Materials
Management
• Karen Purdy-Reilly, Food
Services
• Maggie Bikowski, IC
• Miriam Perez, ESD
Supervisor
Objectives
• Importance of evaluating small tests of change
• Importance of inter- and intra- professional
involvement and team collaboration for
sustainable results