The Unchatables -Time for a New Approach Clinical Excellence - - PowerPoint PPT Presentation
The Unchatables -Time for a New Approach Clinical Excellence Commission Susan Jain RN MN PhD Candidate UNSW, Project Officer HAI Program CEC Susan.jain@health.nsw.gov.au Acknowledgment Prof Mary-Louise McLaws School of Public Health
The World Bank estimates that 24.1 million people could fall into extreme poverty by 2050 because people living in poverty are more vulnerable to antibiotic resistant infection and treating antibiotic resistant infections will be costly and arduous.
procedure (moment 2) for gloved hands reached a 40%.
are one and the same may contribute to inappropriate glove use
potentially infectious may contribute to increased glove use, and shown to reduce compliance with hand hygiene.
has also has been shown to reduce compliance with hand hygiene.
activities for a particular patient.
Misuse
Gloves
Wilson et al. 42% Girou et al. 64.4% Fuller et al. 16.7% Fuller et al. 21.1%
Thompson et al. 84% Naderi et al. 40.6% Katherason et al. 74.3 % Loveday et al. 37%
Risk of cross- contamination Used in Low risk Not Used in High risk
approximately 62,000 boxes of gloves (94,00 000 gloves) are used per year.
$600,000 per year – just for non- sterile glove.
the impact on the planet
‘Is this another example of being too lazy to follow basic hygiene or perhaps they are taught that wearing gloves solves all problems? So, who is the more hygienic: the carer who wears gloves but doesn’t wash her hands or my wife who doesn’t wear gloves but does wash her hands?’ “Tony Nicklinson is paralysed and relies on 24-hour care. Here he questions why carers wear gloves for non-clinical procedures”
‘Carers would pet my dog but they wouldn’t touch me without gloves‘
compliance only.
impact of glove use on hand hygiene compliance is not yet fully understood
“If you’re going to put on the gloves and if you’re touching something that's contaminated, you take it
hands at least you had the gloves
“I think I want some evidence of like, on the benefits, if I saw some sort of research, in a simple statistic or something, this is why it’s beneficial then it will be something great I think” “I reckon it would need to [show] how much it protects the nursing staff by just doing hand hygiene.” “I don’t want to take you know, [or] contract [infection] and then take it home and spread it to my family you know?” “Like fast paced putting on gloves and hand hygiene together is not easy, it’s either you put on the gloves or hand hygiene
quasi-experimental studies of varying quality.
prevention and control literature, and decisions can
consensus.
methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) from their ungloved hands after routine (dry contact) contact with patients who are known to be colonised with either MRSA or VRE.
hygiene with alcohol-based hand rub (ABHR) or soap- and-water wash after routine clinical care (dry contact)
MRSA or VRE.
5 10 15 20 25 30 35 40 MRSA VRE MRSA VRE MRSA VRE 2pumps 3spumps Soap and Water 2 38 40 40 40 40 40
Bacteri rial C Contamination o
HCWs H Hands nds post Hand nd Hygien ene e
Positive No growth
Risk assess for body substance exposure and don gloves if needed Remove gloves immediately after the episode of care Remove gloves immediately after the episode
Risk assess and don a fresh pair
How important is it to wear gloves when taking care of patients under Contact Precautions?
I wear gloves because it’s a protection to
that little bit of a security of walking into an infectious room and knowing I’m safe I would come in with the same pair of gloves, come out with the same pair of gloves, then not think about the five moments of hand hygiene in between I pretty much look at them as protection for myself . I think a lot of people feel a lot safer behind gloves Gloves for me and hand hygiene for my patients
Well I just see it as, kind of the gloves as an outer layer of skin, you know, and like that skin, therefore you put another one {gloves} on without washing hands I’d still see that as an acceptable step in between you walk in - there’s a little picture on the door and the first little picture on the door says, “You put your gloves on and you put your gown on”. And {you are permitted} to enter this space as long as {you have} the little barrier I feel like you're less likely to do the more moments of hygiene if you’ve got gloves on And you're not thinking, I’ve just touched that, I need to clean my hands, because you can’t actually feel that thing because you're wearing the gloves
More layers of skin gives better protection and less hand hygiene
HWs using pre-trial focus groups (N = 12), hand microbiology (N = 40), development
trial of modified poster (n = 100), post-trial focus group discussion (n = 22), and a survey of HWs post-rollout in additional locations (n = 76).
I don't even want gloves
patient, immediately clean my hands straight
change I think it prompts you to do your hand hygiene. It makes you really
these gloves You can still use your judgment, they’re still there if you need them, and you can make that decision yourself before you put {gloves on}, and that ability to make the decision of your own judgement, I like, {it} totally floats my boat Gloves or no gloves is hand hygiene that protects you I found this to be quite empowering for the nurses, increased our clinical judgment,
was a major plus from my point
dictatorship as it was before with the contract precautions sign saying you have to do this there and then, it just gave us a lot of decision making and I think that kind of made our jobs as nurses more satisfying
You’re using your judgment because you don’t know who’s got what – it’s documented in the notes that this patient has so and so, it doesn’t mean the next patient doesn’t have it, so again, depending on what contact you’re making with that patient {make the decision to glove or not} (The new poster is} Great, {its} practical, as a practitioner it makes a lot of sense. You can go in and make your assessment. Later if you’ve got to put them {gloves} on I’ve noticed myself – even if I am wearing gloves and doing two different things in a room, I’ve noticed I’m changing the gloves more often or you know, using the alcohol rub between them more than, what I probably used to Glove rackets used to refill like every day, now they
second day or third day. It’s like very less now. More than 50 percent
precautions guidelines are realistic, increases clinical judgment, promote risk assessment approach and autonomy on whether to wear gloves or not thus increases hand hygiene compliance and better patient
“You, Herr Professor, have been a partner in this massacre.” To another he wrote: “Should you, Herr Hofrath, without having disproved my doctrine, continue to train your pupils [against it], I declare before God and the world that you are a murderer and the ‘History of Childbed Fever’ would not be unjust to you if it memorialized you as a medical Nero” (Ignaz Semmelwise 1847)