1. Infection Prevention… Strategies for Success
Mairead Hickey, PhD, RN, FAHA
Chief Nursing Officer and Senior Vice President Patient Care Services Brigham and Women’s Hospital

2. Discuss the role of the Chief Nurse in Infection Prevention and related “culture charges”
Present strategies that have worked at BWH
Review samples of infection prevention data
Review BWH Balanced Scorecards

3. Role of CNO in Infection Prevention
Create/support a culture of improvement…
Demonstrate a commitment to change and improvement based on evidence
Communicate and stay engaged
Provide resources and remove barriers
Celebrate successes

4. What does this look like at BWH?
Multipronged Approach…
CNO – CMO Leadership
RN – MD – Infection Prevention Leadership triads at a unit level
Unit-based champions
Nursing Quality Committee
ICU Committee:
MD – RN leaders
Review monthly data
Develop/standardize ICU protocols
And more

5. Hand Hygiene and VRE Improvement Project
Unit Example:
Hand Hygiene and VRE Improvement Project

6. Unit Example:
When we looked at unit hand hygiene rates, we saw much variability and rates below 90% compliance.

7. Action Team Brainstorming Ideas: What are the defects?
Unit Example:
Action Team Brainstorming Ideas: What are the defects?
I can’t find the Purell
I have to walk all around the unit to find a laundry basket
If I have to change gloves in the room, new ones aren’t available
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
Ideas from the team included:

8. What Happened? High Reliability Concepts (Roger Resar)
Unit Example:
What Happened?
High Reliability Concepts (Roger Resar)
Process versus outcome
Standardization
Identification of Defects
Daily Huddle
What went wrong?
What went right?
What would you change?
As part of the process, we pulled from the high reliability concepts.
What is getting in the way of performing hand hygiene, can we standardize expectations, can we resolve issues identified? We agreed to standardize the need for hand hygiene before entering the room & encouraged everyone to give feedback if others were not performing to this level. We met daily Monday through Friday for a quick 15-minute huddle with any staff available on the unit.

9. Measures Implemented after Huddles
Unit Example:
Measures Implemented after Huddles
Infection Control In-services
New Precaution Gowns
Laundry Hampers in each room
BP cuffs & Stethoscopes for each Patient Bed
Glove box holders in each room
Reminder Cards on outside of door to use Purell
May
Purell on the inside of the door in patient room
June
Dirty tray holder on unit*
July
As a result of the huddle, the following measures were implemented. We can honestly say that staff initially were resistant the huddle concept and believed ideas raised would take a long time to fix. By working as a multidisciplinary team (housekeeping, unit secretary, PCAs, RNs, MDs, Ops manager link with engineering and materials management) we were able to get ideas in place quickly and evaluate whether it worked or did not work. In May, we saw a decline in rates after patient contact. Staff joked that if they had Purell on the inside of the door it would make it easier to perform hand hygiene. Within a few days, Purell was installed on the inside of the door and the rates improved.

10. Unit Example:
Identified need for Purell
As you exit the room

11. Was This Initiative Sustainable?
Unit Example:
Was This Initiative Sustainable?
Hand Hygiene
FY %
FY %
FYTD (Feb) %
VRE Rates/1,000 line days FY FY
FYTD (as of Feb)
Initially after the huddles ended, 6B did have a reduction in hand hygiene rates. We uncovered staff needed further education surrounding need to perform hand hygiene as a final step. At times, staff would Purell, put on gloves & then be called to phone or desk & not re-do hand hygiene. Once this re-education was completed, rates raised & were sustained. We believe the grassroots effort helped to change the unit culture and ability to provide feedback to each other. In addition, identifying and fixing defects in the environment in a way to make hand hygiene easy had a tremendous impact on the sustainability of the work.

12. Infection Control Data on the BWH Balanced Scorecard