Published: August 21, 2019
Maria Greskowiak, BSN, RN, CHPN has been a nurse for over 20 years, and is currently an Infection Preventionist and the Manager of Education for Gulfside Healthcare Services in Tampa, Florida. Through her roles, she works to highlight the importance of hand hygiene throughout the health care continuum. Here, she shares her experience in piloting an innovative technology to measure and improve hand hygiene in non-traditional health care settings.
The importance of infection prevention and good data
Gulfside Healthcare Services provides hospice, palliative, and home health services throughout Pasco County, Florida. Their services often go beyond a traditional hospital setting, supporting many patients who are critically ill at their in-patient center or in the comfort of their own home. With a focus on palliative care and hospice, it is especially critical for healthcare workers to practice proper hand hygiene. Maria explains, “Hand hygiene is the foundation of infection prevention and in hospice especially, we want to help patients have the chance to make every day count and live life to the fullest. Infection affects their quality of life, so really this is a safety and quality initiative for us.”
To ensure patient safety, Gulfside places high priority on ensuring all healthcare workers practice proper hand hygiene during critical moments of care. They have Infection Preventionists like Maria to ensure healthcare workers have training opportunities and to reinforce hand hygiene policies. Gulfside also used direct observation and a phone app to measure hand hygiene practices among healthcare workers. These activities, while a standard form of hand hygiene promotion and measurement in many health care settings, have some challenges. For instance, the Hawthorne Effect (people stating they washed their hands when they knew they were being watched) prevented Maria from collecting good data that accurately measured healthcare workers’ hand hygiene practices.
Discovering the SafeHaven Personal Hand Hygiene System
Maria wanted to do more than the standard hand hygiene promotion and measurement processes, but she needed a way to measure more actionable hand hygiene data. Gulfside has a daily average of 500 patients with a vast majority of patients being cared for in their home. While other electronic monitoring systems were mostly geared toward hospital and in-patient settings, often using sensors at a patient room entry/exit or a handrub dispenser to measure hand hygiene compliance, that system was not conducive to Gulfside’s patient population.
At the 2018 APIC Conference, she found the answer she had been looking for as she walked up to Georgia-Pacific’s (GP Pro) exhibition booth where she learned about their new SafeHaven Personal Hand Hygiene System. The SafeHaven Personal Hand Hygiene System cleans hands, measures hygiene events, and encourages performance through positive reinforcement. The personal, portable sanitizer device contains replaceable cartridges of antiseptic handrub gel that can be clipped onto a healthcare worker’s waistband, empowering caregivers to perform more hand hygiene at points of care. It boosts hand hygiene performance by setting achievable hourly goals and providing nudges to encourage hand hygiene practice. Hand hygiene events are then collected wirelessly and displayed on a dashboard that allows healthcare staff to visualize where they stand in regards to hand hygiene compliance. Maria states, “I needed something that was applicable to the home-based environment and the SafeHaven system provided just that.” Because the system is portable and attached to each person, it is able to count hand hygiene opportunities no matter the setting.
Piloting the implementation of a new system
Maria and her team conducted a pilot study, implementing the new system in three phases (and settings) to examine the system’s impact in providing quantitative indicators for hand hygiene. The first phase focused solely on teams that go into patient homes, looking at the system’s effectiveness in measuring in a home environment. The second phase looked at teams that went to assisted living facilities or skilled nursing facilities, while the third phase of implementation was set in Gulfside’s in-patient unit, which was most like other acute care facilities. Maria said she was “most excited to see what [they] would see in the home environment, since there haven’t been many studies focused on the home.”
In each setting, there were pre-determined goal rates for hand hygiene based on a healthcare worker’s role and setting. For instance, for a nurse in a home setting, their goal rate was a minimum of 5 hand hygiene events per visit. These rates were determined based on CDC guidelines and understanding the critical moments for hand hygiene in different settings. Maria set goals for each role that had direct patient contact at Gulfside (i.e. nurses, nurse practitioners, aides, physicians, chaplains, and social workers). In phases one and two (home and assisted facilities), the hand hygiene goal rates were the same. In phase three, however, she adjusted the goal rates based on the change in shifts and care environment. “Setting the goal rates was a real learning process. I originally had the home nurses’ goal rates at 8 per visit and saw that they weren’t meeting those goals. We reviewed each hand hygiene scenario they would encounter and realized that 8 had been too high.”
Factors that drove to implementation success
From the start, there was good engagement from Gulfside staff, in part, because it was a more collaborative approach to hand hygiene. Prior to implementing the SafeHaven Personal Hand Hygiene System, healthcare staff did a survey on their hand hygiene perceptions and monitoring, allowing staff members to voice their perspectives on hand hygiene practices in different health settings. Staff also had the opportunity to choose the color of their portable sanitizer device. While its seemingly a minute detail, it was important for staff to have that choice as they would have to wear it on their person throughout the day. Maria explained, “Seeing the color that they chose made a real difference. It enhanced their engagement with the product. It’s the personalization of the device that makes a difference for the staff.”
While the SafeHaven Personal Hand Hygiene System measures the amount of times each staff member is using the provided handrub, it does not cue healthcare staff of a hand hygiene event or missed opportunity. Therefore, it was especially important to train staff on the fundamentals of hand hygiene, like critical times to wash and the amount of handrub needed to help staff reach their goal rate. In her trainings, Maria often used the example of glove size to emphasize the importance of amount use – “We don’t all wear the same sized gloves. I wear small-sized gloves, while another guy could wear large-sized gloves. We don’t have the same sized hands, which means we don’t need the same amount of handrub. I may need just one cartridge of sanitizer per day, while someone else may need two.” The goal of her metaphor was to get staff to realize that hand hygiene is not effective unless they do it consistently and properly.
The success of SafeHaven also relied on its ability to provide specific data points for each staff member’s hand hygiene practices. Maria states, “SafeHaven helped make my data actionable. The system allows me to see who is meeting their goal rates and who is not, so I can really zero in on those who were not as compliant.” As an Infection Preventionist, she had never had data like that prior to SafeHaven. Staff were also able to see how they were performing as a group, and the dashboard highlighted the top two performers for each role, which brought up the level of engagement. Each week, every staff member would also get a report of their individualized hand hygiene data, increasing the accountability and allowing staff members to tie their actions to specific data points.
Key takeaways from this project
Maria’s pilot study using the SafeHaven Personal Hand Hygiene System was groundbreaking because there was nothing to compare that data to. She and her team trailblazed the measurement of hand hygiene in home settings, leveraging the SafeHaven Personal Hand Hygiene System to determine a more actionable way to ensure hand hygiene on an individual level.
Her study measured total number of hand hygiene events and provided reports and analytics on specific healthcare roles. Prior to the implementation of SafeHaven, Maria strived for 60 observations per month. Over the 9-week pilot study, Maria collected over 21,000 hand hygiene events, allowing her to more accurately report on hand hygiene practices. “The whole point of this is to prevent infection and improve the quality of patient lives. With the old method, I would say we had 90% compliance in this location, but it didn’t change an individual’s hand hygiene practices. I had data, but I could not necessarily act on it on an individual level. Now, I can take this data and improve staff performance because I know that this affects our patients.”
She also nodded to the importance of staff engagement. Like many health facilities, Gulfside had a routine to encourage hand hygiene. However, the staff had heard the same messages for years. This initiative, on the other hand, was a new and fresh approach that staff members actually enjoyed because it brought hand hygiene to the forefront of their patient visits. Healthcare workers often have competing priorities pulling their attention, so having the device on them nudged them to recognize the importance of hand hygiene. Using encouraging and collaborative messaging allowed this project to be a success and allowed staff members to take ownership of their practices moving forward.
Her last takeaway from this project was the importance of leadership in these efforts. When she initially proposed the idea of a hand hygiene trial using the SafeHaven Personal Hand Hygiene System, Gulfside leadership immediately supported her in her efforts. This allowed her to spearhead a path to bring hand hygiene and infection and prevention control to the level of excellence the organization strives for. In closing, when asked about her favorite aspect of this project, Maria said, “it’s that peer-to-peer accountability and creating that culture where hand hygiene is cool. That is where I saw change and that is so exciting. Hand hygiene is a vital part of patient safety and quality care and I’m so excited to be part of an organization that supports me in these efforts.”
Photos courtesy of Maria Greskowiak.
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