1. How Huddles Improved Hand Hygiene and Reduced VRE A reflection on our journey

2. Overview Identification of the problem:Identification of the problem: –Rising VRE rates Use of high reliability concepts for changeUse of high reliability concepts for change End resultsEnd results

3. Commercial Interest Disclosure: Colleen ZidikColleen Zidik How Huddles Improved Hand Hygiene and Reduced VREHow Huddles Improved Hand Hygiene and Reduced VRE The presenter today has no commercial interests to disclose.The presenter today has no commercial interests to disclose.

4. Objectives: Importance of evaluating small tests of changeImportance of evaluating small tests of change Importance of inter- and intra- professional involvement and team collaboration for sustainable resultsImportance of inter- and intra- professional involvement and team collaboration for sustainable results

5. Curtains Action Team

7. What Happened? High Reliability Concepts (Roger Resar)High Reliability Concepts (Roger Resar) –Process versus outcome –Standardization –Identification of defects –Daily Huddle (Mon - Fri) What went wrong?What went wrong? What went right?What went right? What would you change?What would you change?

8. Action Team Brainstorming Ideas: What are the defects? I can’t find the PurellI can’t find the Purell If I have to change gloves in the room, new ones aren’t availableIf 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 basketI have to walk all around the unit to find a laundry basket How is the BP cuff cleaned between patients?How is the BP cuff cleaned between patients? I didn’t know the impact HCAI had on PatientsI didn’t know the impact HCAI had on Patients These yellow gowns do not provide enough protectionThese yellow gowns do not provide enough protection

9. Measures Implemented Glove box holders in each roomGlove box holders in each room –Reduced # glove boxes stocked on cart, making Purell holders visible & accessible Laundry Hampers in each roomLaundry Hampers in each room –Initial trial used trash cans designated for laundry BP cuffs & Stethoscopes for each Patient BedBP cuffs & Stethoscopes for each Patient Bed –Cleaned by UA after discharge Infection Control In-servicesInfection Control In-services New Precaution GownsNew Precaution Gowns

10. YesNoWhy? 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?

11. 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

12. Identified need for Purell As you exit the room HCAI In-services began

13. HCAI In-Services began Huddles occurred May-July

14. Was This Initiative Sustainable? Hand Hygiene FY2008 84%FY2008 84% FY2009 88%FY2009 88% FYTD (Feb) 2010 94%FYTD (Feb) 2010 94% VRE Rates/1,000 patient days FY2008 4.7FY2008 4.7 FY2009 2.2FY2009 2.2 FYTD (as of Feb) 2010 1.9FYTD (as of Feb) 2010 1.9

15. Questions? Impact on small tests of change?Impact on small tests of change? Impact of inter- and intra- professional collaboration?Impact of inter- and intra- professional collaboration?

16. Original Action Team Members Rebecca Spitz, RN NICRebecca Spitz, RN NIC Carolyn Clark, UCCarolyn Clark, UC Stephanie Carroll, PAStephanie Carroll, PA Rob Schlossman, MDRob Schlossman, MD Candy Hsieh, RN ICCandy Hsieh, RN IC Susan O’Rourke, RN ICSusan O’Rourke, RN IC Rose Villarreal, PA ICRose Villarreal, PA IC Marsha Milone, RN ANMMarsha Milone, RN ANM Jeanne Barton, Dir. Operations ManagementJeanne Barton, Dir. Operations Management Luis Soto, Asst. Dir. Environmental ServicesLuis Soto, Asst. Dir. Environmental Services Jeannie Keith, RN NMJeannie Keith, RN NM Colleen Zidik, RN QPMColleen Zidik, RN QPM Tamara Devlin, Ops Sup Andy Madden, Dir. Materials Management Karen Purdy-Reilly, Food Services Maggie Bikowski, IC Miriam Perez, ESD Supervisor

17. Objectives Importance of evaluating small tests of changeImportance of evaluating small tests of change Importance of inter- and intra- professional involvement and team collaboration for sustainable resultsImportance of inter- and intra- professional involvement and team collaboration for sustainable results