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Reducing HCAIs
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TOPIC: Good news or Big Brother?

Re: Good news or Big Brother? 3 months, 3 weeks ago #16

It is fascinating to read of the opinions expressed in this vital blog series. I was in on the cleanyourhands campaign in 2004, and delighted to preceded alcohol hand rub veing introduced to every bed and frequent 'point of care' area in the NHS trust where I had a Lead role.
Big brother...not so we started with local ownership, my rteam colleagues and I did Trust-wide trolley dash with the three recommended user friendly and effective biocidal hand rubs/gels used in the Campaign...We let staff decide which of the handrubs would be implemented in the Trust. We invited everyone from porters consultants cleaners clinical and administration staff and public and patients in at the time to have they say in an anonymous survey vote. The posters of the 'slogans' don infect protect etc change every few months and own local 'Champions' took lead physicians, nurses, housekeeping staff , estates staff the Chief executive etc..it began the campaign to improve hand hygiene on a high note..rather than big brother.

Hand hygiene audit could have had the 'big brother'  feel, and it was important to me that it had simply the message we can cause infection or prevent it...it's up to us...but with the right resources to care for our skin...moisturisers were implemented everywhere, and technique was revised to ensure staff new it was about water first, soap, rinse and dry correctly performed, this education, resource and ownership and responsibility was more palatable, there was less resistance to it..always some!! But poor practice scores, hand hygiene opportunity missed provided with feedback and support to change led to considerable improvement...we did not use the technologies available, it was labour intensive, and so regular that the temporary 'Hawthorn effect' didn't last long; but staff new they mattered too. We encourage patients to ask? but I have to say this was never a successful part of the campaign...

We need to engage staff with their own emotional and knowledge based intelligence, provide the right resources and be constructive but clear about 'zero tolerance to avoidable infection...it's culture that needs to be created with handwashing/alcohol handrub right first time every time it's mantra....doesn't need to be big brother to work..I think a beneficient panoptican is what we need putting our patients first, and ensuring staff know they matter and have responsibility and accountability for their own actions...but they will have the back up to do the 'right thing' too.....sorry guys long one LOL

Re: Good news or Big Brother? 3 months, 2 weeks ago #17

I agree with Cathy in that the first scrub of the day should be an aqueous based antimicrobial soap and water but this should then be followed up by an alcohol gel until th ehands are visibly grimy or a toilet/lunch breakl occurs. Using each of these with chlorhexidine would add a greater benefit because it not only offers the sustained and residual effect against bacteria. fungi and non-enveloped viruses, but also the cumulative effect, i.e. it builds up its efficacy with each subsequent use by binding to the stratum corneum awaiting any bugs it mat come nto contact with.

I delivered a presentation for a Theatre nurse friend of mine recently to a group of Sales people and that contained the "Wheel of Infection"... a diagram that pointed out the route of cross-contamination and illustrated how hand washing can remove the risk of passage at every step along the pathway... it made so much sense that even the Sales personnel understood it ;-)

With that in mind, i'd like to point out a recent paper (2010) by Widmer AF et al. in J. of Hosp. Infection.... "Surgical and Preparation: State of the Art" which not only points out quite succinctly the history and the reasons as to why hand hygiene is so important... but it also explains proper technique (although admittedly, it doesn't seem to mention the adequate rinsing off of the soap and water which is needed to reduce the chance of Dermatitis).

With regard to Gwen's Big Brother statement below... I am all for remote auditing to promote compliance and show that you are using the correct technique... after all, if you are not doing anything wrong with your hand hygiene technique, then what exactly have you got to hide???

Re: Good news or Big Brother? 3 months, 1 week ago #18

The non-medical side of the NHS is run on a culture of complacency and concealment, with a well developed propaganda machine, creating notable false impressions. The only route to saving it is through strong LA management on the lines through which it originated. Hand Hygiene 'Big Brother' is just another example of something that should be a simple matter of manners and personal hygiene being over complicated and it is a shame that Doctors and nurses need it enforcing.
Last Edit: 3 months, 1 week ago by Matthew Abbott.

Re: Good news or Big Brother? 3 months, 1 week ago #19

I agree with otheres that the blame culture won't help. It's not only doctors who do not wash their hands, all disciplnes of staff are guilty. Unfortunately sometimes the managers are not the role model they should be. To change culture we have to educate staff and that should start from day 1 of training, and managers need to be more proactive.


Re: Good news or Big Brother? 3 months ago #20

Hi, I agree that there isn't a category of people who are more compliant than others, so if a monitoring system were to be implemented then it should be applied for every person involved in patient care. However, if it is to be implemented it needs to be done in a reasonable way, i.e., that the costs of the system are justifiable, how many people are monitored, for how long or how frequently, and what are the benefits for both staff and patients, and ultimately that non-compliance will not lead directly to disciplinary action.
There should also be a clear difference between being "recommended" instead of "mandatory" as I personally believe people tend to be more compliant when it allows to show "how good we are" instead of "because I have to".
Finally, if after years and years of training, Hand Hygiene is still an issue in healthcare then certainly a Training+ Monitoring system will be more effective at changing the culture than the first one alone.
Kind Regards,
Vera Cabral

Re: Good news or Big Brother? 3 months ago #21

It sometimes feels like IPC teams are expected to police wards and units, but in fect as we all know that infection prevention is everyone's business, and what is required is strong leadership from the top in an organisation to ensure that all levels of staff know what is expected of them and that a multi facited approach be taken and if that means the use of other measures surely that can only help. Moreover I agree with the person saying if you have a 'blame culture' embedded within your organisation it will certainly seem very 'big brother'. I don't think it is unrealistic to expect all healthcare workers under normal conditions to be 100% compliant and we should strive to achieve this across all disciplines.

Re: Good news or Big Brother? 6 days, 8 hours ago #22

It is good news in the sense that people are always aware they are being watched and therefore would endeavour to adhere to best infection control practice. It is a shame though that these technologies have to be introduced to enforce compliance when as professionals in the healthcare you would think staff would always make it a point to deliver the best care to patients including putting measures in place to avoid HCAIs. One of our trust values is putting patients first, so it does not matter how senior one is, they still need to do hand hygiene like everyone else. if it takes technology to get compliance from everyone, so be it!!
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