Many organizations have historically focused hand hygiene improvement efforts on the health care provider's and visitors they interact with daily. However, have we stopped to consider that perhaps we are forgetting the most important people within the health system, the patients!

1. WELCOME….
TO OUR WEBINAR
HAND HYGIENE…NOT
JUST FOR HEALTHCARE
PROVIDERS ANYMORE!

2. Our Panelists for today…
Anne MacLaurin,
Patient Safety
Improvement Lead,
CPSI
Gina Peck,
Project Coordinator
CPSI
Jason Thompson,
Communications Officer
CPSI

3. Please write down your questions for the
end of the presentation or put them in the
chat box or in the Q&A box
 Slides for today’s
presentation
 Today’s call will be recorded
Before we get started

4.  Our partners:
 Our sponsor:
Thank you!

5. Be like Anne and Pat

6.  Use #pledgecleanhands on social media
 Gallery of all the pledges online
I pledge to clean my hands. Do you?

7. Our Guest Speakers…
Jignesh Padia
Dr. Jocelyn Srigley
Josée Shymanski
Pat Malone

8. Jignesh Padia
Message from Patients for Patient
Safety Canada

9. PATIENT EXPERIENCES
Surgical Site Infections

10. Hi!
My name is Jignesh Padia. What brings me to this session is our ongoing
care episode for my 4 year old son and some of the very positive
experiences we had during his spinal cord detethering surgery.
Before surgery, we were very concerned about the infection. Especially
because we learned that a spinal cord infection could easy result in serious
condition affecting our child’s development and future.
We are very thankful to entire Neurosurgery Team and all the staff at
Stollery’s for providing a positive outcome for my son’s surgery.
Background

11. Summary of our surgical
experience
What went well…..
 We were provided antimicrobial soap
for preoperative bathing at home.
 We actively noticed rigorous hand
hygiene by Neurosurgeons.
 During post surgical follow-ups
Neurosurgeon always sanitized their
hands before touching or examining
the wound.
 Sanitizing hands in front of us as a
parent gave us more confidence in the
providers taking care of our son.
Potential opportunities…..
 Instruction on how many times and how to use
soap were verbal. A written instruction (one
pager) could ensure that parents are able to
follow instructions to the point for better
outcome.
 We had experienced that Nursing staff on the
ward were less compliant and would even touch
the wound without sanitizing hands after
entering in the room.
 Ward floor was only mopped once everyday
and by the end of shift you could visually see
dirt on the floor. There was an opportunity for
things such as catheter lines and other probes to
touch the floor and get contaminated.

12.  Below pictures show what are some of the risks for patients and especially
young kids who get infected post surgery.
 Many factors could cause such infections and each step to prevent it becomes
important.
 In the below picture you are seeing a baby who got infected post surgery. The
parents of this baby are Facebook friend of ours. They told us that they never
got any soap or instruction to clean their baby before surgery.
Risks….

13. Risks….
 Another Facebook
friend, who also had not
so positive outcome post
surgery.
 Their baby required
multiple surgeries as a
result of recurring
infections.

14. Other stories from family
friends…
Infection Post “C” section
 Person had elevated blood glucose
prior to going for “C” section.
 No Antibiotic was given prior or
immediately after the surgery.
 Surgical wound got infected and
now the mother is going through
hardship while coping with new
baby.
 Most of her time is spent in
appointments and follow-ups
regarding this infection.
Death of pediatric Cancer Patients post
surgery for “pic” lines
 There has been many known cases
were pediatric cancer patients died
post surgery.
 In many cases the inserted “pic” line
or tube started the infection.

15.  They are worried about infections and want to do their part
– Ask for / Provide information about what they can do to prevent it
• Many times (at arrival, during care, etc),
• Many channels (written, 1:1 conversations, etc),
• Many voices (physician, nurse, patient advisors, cleaning staff)
– Ensure soap/ sanitizer and other equipment is available
– Be a role model
• Wash/ clean your hands in front of the patients/providers
• Explain why and how you do it
• Ensure all staff follow the same processes
Patient/family needs

16.  By participating in this important work, you have already
shown the leadership.
 Please spread the surgical check list and its use to each
and every part of your organization.
 Promote best practices and most importantly hand
hygiene.
 Thanks for listening and being passionate about this
topic.
You can make the difference

17. Jocelyn Srigley
Hand Hygiene Related to Patients &
Family

18. PATIENT HAND HYGIENE:
WHAT’S THE EVIDENCE?
Jocelyn Srigley, MD, MSc, FRCPC
Provincial Health Services Authority
Vancouver, BC

19. Outline
 Does patient hand hygiene matter?
– Evidence for transmission via patients’ hands
 Do patients perform appropriate hand
hygiene?
– Data on patient hand hygiene rates
 How do we improve patient hand hygiene?
– Existing evidence for interventions

20. Evidence for Transmission from Patient
Hands
 Plausible routes of transmission
 Data on patient hand colonization
 Evidence that improving patient hand
hygiene decreases infection rates

21. Transmission via Patient Hands
Fecal-Oral Indirect Contact

22. Evidence for Transmission from Patient
Hands
 Plausible routes of transmission
 Data on patient hand colonization
 Evidence that improving patient hand
hygiene decreases infection rates

23. Multidrug-Resistant Organisms on
Patients’ Hands
 357 patients admitted to 6 post-acute care
facilities
 Baseline hand carriage:
– MRSA 10.9%
– VRE 13.7%
– Resistant Gram negative bacilli 2.8%
– Any MDRO 24.1%
1Cao et al, 2016.

24. C. difficile Spores on Patients’ Hands
 44 patients with C. difficile infection (CDI)
or colonization
 15 (34%) had positive hand cultures before
hand hygiene
2Kundrapu et al, 2014.

25. Evidence for Transmission from Patient
Hands
 Plausible routes of transmission
 Data on patient hand colonization
 Evidence that improving patient hand
hygiene decreases infection rates

26. Systematic Review Results
Author
(Year)
Study Design Study Setting
Participating
Patients
Recipients of
Intervention
Elements of
Intervention
Results: Healthcare
Associated Infections
Results: Hand
Hygiene Rates
Pokrywka
(2014)
Before-after 520-bed tertiary
care and teaching
hospital
All inpatients Both Education,
reminders,
provision of
product
CDI rate 10.45/ 10,000
patient days before to
6.95/ 10,000 patient
days after; p=0.0009
N/A
Gagne
(2010)
Before-after 250-bed
community
hospital
All inpatients Patients Education,
provision of
product
MRSA 10.6/ 1,000
admissions before to
5.2/1,000 admissions
after
N/A
Cheng
(2007)
Before-after Inpatient
psychiatric
department
Long-stay
psychiatric patients
HCWs Provision of
product
6 outbreaks affecting 66
patients (18.2%) before;
4 outbreaks affecting 23
patients (4.4%) after;
p=0.005 for total
patients involved
N/A
Thu
(2007)
Controlled
before-after
2 neurosurgical
wards
Inpatients who had
undergone a
neurosurgical
procedure
Patients Education,
provision of
product
SSI decreased from
8.3% to 3.8% on
intervention unit and
increased from 7.2% to
9.2% on control unit;
p=0.04 for comparison
between units
N/A
Hilburn
(2003)
Before-after Orthopedic
surgical unit
N/S Patients Education,
reminders,
provision of
product
Nosocomial infection
rate 8.2% before to
5.3% after
N/A
Peters
(1992)
Before-after
with repeated
treatment
Maternity ward Postpartum women Patients Provision of
product
Puerperal mastitis
2.90% before to 0.66%
after; p<0.001
N/A

27. Outline
 Does patient hand hygiene matter?
– Evidence for transmission via patients’ hands
 Do patients perform appropriate hand
hygiene?
– Data on patient hand hygiene rates
 How do we improve patient hand hygiene?
– Existing evidence for interventions

28. Indications for Patient Hand Hygiene
 After toileting (after body fluid exposure)
 Prior to eating
 Before leaving their room
 After entering their room
 Before aseptic procedures

29. Self-Reported Hand Hygiene Rates
 Emergency department patients reported
hand hygiene after 62-88% of bathroom
visits and after 13-41% of bedside
urinal/bedpan uses
3Luz et al., 2011.

30. Direct Observation of Patients
 “Covert observation” by junior doctors
found hand hygiene performed by patients
during 73% of meals4
 Patient/visitor hand hygiene compliance was
67.5% after body fluid exposures and 50%
after contact with patient surroundings5
 Study on pediatric wards only found 1 child
to observe, who had 100% compliance6
4Mattam et al., 2012. 5Randle et al., 2010. 6Randle et al., 2013.

31. Electronic Monitoring of Patients
 Hand hygiene on a multi-organ transplant unit measured by
a real-time locating system for 9 months
 After using the bathroom
– 29.7% of 12,649 bathroom visits
 Before eating
– 39.1% of 6,005 meal times
– Ranged from 32.2% at breakfast to 45.9% at dinner
– 3.3% of 1,122 kitchen visits
 Room entry and exit
– 2.9% of 5,786 entries and 6.7% of 5,779 exits
7Srigley et al., 2014.

32. Outline
 Does patient hand hygiene matter?
– Evidence for transmission via patients’ hands
 Do patients perform appropriate hand
hygiene?
– Data on patient hand hygiene rates
 How do we improve patient hand hygiene?
– Evidence for interventions

33. Surgical Site Infections in Neurosurgery
 Controlled before-after study
 785 patients on 2 neurosurgical units in Vietnam
 Intervention
– Inpatients on 1 unit given ABHR and education
 Surgical site infections decreased from 8.3%
to 3.8% on intervention unit and increased
from 7.2% to 9.2% on control unit (p=0.04 for
comparison between units)
8Thu et al.

34. Mastitis on a Maternity Ward
 Before-after with repeated treatment
 ~2300 postpartum women on a maternity ward in
Germany
 Intervention
– Patients provided with ABHR at bedside x 10 months,
then withdrawn x 2 months and reinstated x 2 months
 Puerperal mastitis decreased from 2.90% in
controls to 0.66% in intervention patients
(p<0.0001)
9Peters et al.

35. MRSA in a Community Hospital
 Before-after study
 250-bed community hospital in Quebec
 Intervention
– All inpatients given education and alcohol-based hand
rub (ABHR) BID x ~1 year
 Nosocomial MRSA rates decreased from
10.6/1,000 admissions in the year before to
5.2/1,000 during intervention
10Gagne et al.

36. Outbreaks on a Psychiatric Unit
 Before-after study
 ~900 inpatients admitted to a psychiatric unit in Hong
Kong
 Intervention
– Staff gave ABHR to all patients Q4H during the day x ~1 year
 Decrease in nosocomial outbreaks during the
intervention compared to the year before
– From 6 outbreaks affecting 66 patients (18.2%) to 4
outbreaks affecting 23 patients (4.4%) (p=0.005 for total
patients involved)
11Cheng et al.

37. C. difficile in a Teaching Hospital
 Before-after study
 520-bed teaching hospital in the USA
 Intervention
– Education, reminders, and alcohol wipes on meal trays
– Staff and volunteers encouraged to clean patient hands at
mealtimes
– Added to an existing CDI “bundle”
 CDI rate decreased from 10.45/10,000 patient
days before to 6.95/ 10,000 after (p=0.0009)
12Pokrywka et al.

38. HAI Rates on a Surgical Unit
 Before-after study
 Orthopedic surgery unit in the USA
 Intervention
– Patients given ABHR and education x 10 months
– Posters reminded staff, patients, and visitors about
hand hygiene
 Nosocomial infection rate decreased from
8.2% in the 6 months before to 5.3% during
intervention (p-value not reported)
13Hilburn et al.

39. Hand Hygiene at a Pediatric Hospital
 Cluster randomized-controlled trial
 Children’s hospital in the UK
 Intervention
– 6 wards randomized to interactive educational activities
using “Glo-Yo,” mobile learning technology, or control
 Hand hygiene rates increased by 31.7%
among intervention patients compared to
13.8% in control group (p<0.001)
14Lary et al.

40. Hand Hygiene at a Rehab Centre
 Before-after study
 ~100 patients on 3 units of a rehab centre in Sweden
 Intervention
– Patients education and ABHR in bathrooms
– Staff gave out alcohol wipes at mealtimes and were
encouraged to remind/assist patients with hand hygiene
 Hand hygiene rates increased from “seldom” before
intervention to 85% before meals and 49% after
toilet use
15Hedin et al.

41. Hand Hygiene on Surgical Units
 Before-after study
 ~160 inpatients on 3 surgical units in the USA
 Intervention
– Staff education followed by audits to assess whether
they assisted patients with hand hygiene
 Staff assisting with patient hand hygiene at 6
moments increased from 17.3% in the 6
weeks before intervention to 44.6% in the 6
weeks after (p=0.0003)
16Ardizzone et al.

42. Hand Hygiene After Commode Use
 Before-after study
 40 inpatients with mobility difficulties
 Intervention
– Hand wipe containers and reminder signs attached to
commodes
 Patient survey
– Patients offered wipes some of the time increased
from 69% to 100% and all of the time increased from
50% to 85%
17 Whiller et al.

43. Summary of interventions
 Targets
– Patients (5/10)
– Healthcare workers (HCWs) (3/10)
– Both (2/10)
 Components
– Provision of product (8/10)
– Education (7/10)
– Reminders (3/10)
– Audits (1/10)

44. Conclusions
 Patient hand hygiene matters
 Patients do not perform enough hand
hygiene
 Interventions to improve patient hand
hygiene reduce HAIs, but quality of
evidence is low
– Intervention components have been similar to
healthcare worker hand hygiene programs

45. Josée Shymanski
Rapid Fire Presentation

46. PATIENT HAND HYGIENE
It’s just as important!
Josée Shymanski
Hôpital Montfort, Ottawa, ON
May 5, 2016

47. Bonjour! Hello!
Follow me to see what
Montfort is doing to
promote patient hand
hygiene!

48. Main entrance

49. Registration

50. Emergency

51. Short history

52. Patient teaching

53. Evaluation of the teaching session
Survey (n=30)
1. Helpful? YES 100%
2. Washing your hands
more often? YES 60%
3. Asking others? YES
16.7%
4. Staff offering you
alcool gel? YES 3.3%
Comments
Difficult to do by myself,
immobilized, cannot reach,
would like help

54. Pilot projet -hand hygine prior to
meals
A. Distribution of alcool gel from a bottle by the
patient care assistants
B. Distribution of disposable wipes from a
container by the dietary staff
C. Distribution of disposable wipes from a
container by the patient care assistants

57. Volunteer’s perspective
Before meals, we go from room to
room and offer alcool gel to
patients and help them wash their
hands. Patients get use to this
and often they will extend their
hands towards us.

58. Patient care unit

59. Having someone assigned to helping
patients set up for meals and wash
their hands makes a big difference as
staff is often very buzy. The presence
of volunteers on the unit is greatly
appreciated by patients and by the
staff.

60. Patient’s perspective

61. When you are hospitalised,
your routine if different from
what you usually do at home;
it’s easy to forget to wash
your hands. It’s also harder
to wash your hands when
you are immobilised.

62. Mental health program

63. Attention : la cafétéria est
maintenant ouverte pour le diner.
SVP lavez-vous les mains à
l’entrée.
Bon appétit!
Attention: the cafeteria is now
open for lunch. Please wash your
hands at the entrance. Bon appétit!

64. Next steps
1. Measure our performance.
« Is staff encouraging you/helping you to wash
your hands before meals? After going to the
bathroom? » Goal: 80% YES, ALWAYS
2. Promote innovation, share succeses
3. Increase presence of volunteers on patient
care units

65. Questions?
joseeshymanski@montfort.on.ca

66. Pat Malone
Rapid Fire Presentation

67. Saint Elizabeth’s
Journey to Hand
Hygiene Excellence
May 2016

68. 69

69. 70
OUR STRATEGY
 Staff Engagement
 Client Engagement
 System Innovation

70. 71
STAFF ENGAGEMENT

71. 72
STAFF ENGAGEMENT

72. S
73
STAFF ENGAGEMENT
Sharing Results and Celebrating Success
Newsletters
Staff meetings
Client Quality, Risk and Safety Committee
Health and Wellness Advisory Committee

73. 74
CLIENT ENGAGEMENT

74. 75
CLIENT
ENGAGEMENT
AND
PARTNERSHIP

75. CLIENT/COMMUNITY ENGAGEMENT
76
Question of the Month:
Saint Elizabeth requires all of our staff to wash
their hands or use hand sanitizer prior to
providing any care to our clients. We want to
make sure that our staff are complying with this
policy 100% of the time, and that our clients feel
confident in our staff’s hand hygiene
practices. How can we make our hand hygiene
practices the best they can be?

76. SYSTEM INNOVATION
77

77. SYSTEM INNOVATION
78

78. 79
SYSTEM INNOVATION
Celltrak task added to every visit.. What is the
most important thing I can do for you today?
at is the most important thing I can do for you today?
Mark it as √ Completed
Don’t forget to inform the client!
Wash Hands and Inform Client

79. SYSTEM INNOVATION
80

80. A
81
Measurement
Region/Nursing
January
2016
Active Visits
% Compliance –
Q-wash
Q3 NRC
Survey
N Size
Top Box Only
CENTRAL 18834 99.9
123 80.5
CENTRAL EAST 10182 99.9
54 85.2
CENTRAL WEST 7528 99.7
185 84.3
CHAMPLAIN 7038 99.8 106 77.4
ERIE-ST. CLAIR 8478 100.0 57 91.2
HNHB 11044 98.4
114 81.6
MISSISSAUGA-HALTON 8127 99.9
47 80.9
SIMCOE-MUSKOKA 5554 100.0
96 89.6
SOUTH EAST 5360 99.8 105 84.8
SOUTH WEST 11080 99.8
62 83.9
TORONTO CENTRAL 13539 100.0
33 85.1
WATERLOO-WELLINGTON 2673 100.0
82 75.6

81. WHAT WE HAVE LEARNED
82
Partner with clients
Engage and involve staff – so that the campaign is their
own
Keep it active and obvious  be ‘kindly and respectfully’
relentless
Measure and communicate, communicate, communicate
Don’t stagnate – keep it fresh

82. caoncontact
83
QUESTIONS

83.  Use #pledgecleanhands on social media
 THANK YOU FOR ATTENDING!!
I pledge to clean my hands. Do you?