Purpose of the call: •Review process of conducting Hand Hygiene observations •Preparation for the Canadian Hand Hygiene Audit Event

1. Canadian Hand Hygiene Audit Event
Mar 26, 2014

2. Welcome from the team
Bienvenue, de la part de l’équipe
Gina PeckAnne MacLaurin Virginia Flintoft Alexandru Titeu
Hélène Riverin Dr. Michael Gardam Leah Gitterman

3. Where are you joining from? Use your pointer
Où êtes-vous joindrez à partir? Utilisez votre pointeur

4. Discuss the details of the Canadian Hand
Hygiene Audit Event
Review process of conducting Hand
Hygiene observations
Data collection tips for the Canadian Hand
Hygiene Audit Event
Purpose of today’s call

5. Canadian Hand Hygiene Audit
When?
– April 2014
Purpose:
– Create awareness around appropriate Hand
Hygiene practice
– Obtain an estimate of national Hand Hygiene
rates
– Promote the new Data Collection Tool and to
support good Hand Hygiene

6. Canadian Hand Hygiene Audit
Your commitment:
– 50 moments per unit
– Secure executive sponsor support and
resources as required.

7. Who is included?
The Canadian Hand Hygiene audit will focus
on:
– Acute Care
– Long-term Care
– Home Care
Audit sample can be:
– Entire organization
– Specific units or programs

8. Hand Hygiene Observation and
Analysis
Michael GardamLeah Gitterman

9. HAND HYGIENE OBSERVATION AND
ANALYSIS
Leah Gitterman
University Health Network
Infection Prevention and Control

10. Direct observation
Use the 4 moments
Conduct observations openly without
interfering with ongoing work
Anonymous observation
Feedback the data to the front line staff
How to observe hand
hygiene

11. Moment: refers to the 4 times it is essential
that HCW’s clean their hands
Opportunity: need to perform hand hygiene
Terminology
Zimmerman et. al. Healthcare Papers 2013

12. How will you identify types of
healthcare workers?
Introduce yourself to the unit
Learn the workflow of the area you are
auditing
Be open to answering questions from
staff and patients
Preparing to Audit

13. Suggested to observe up to 3 HCW’s at
a time
Each observation session takes on
average 20 minutes (can be some
variability here)
Try to audit at different times/shifts
Preparing to audit

14. How to use the form
• Each column is for recording hand hygiene opportunities of one health
care provider only. Use additional columns for each additional health care
provider being observed
Note: The Long-Term Care Observation Tool uses “Category” instead of
HCP.
• As soon as you observe the first indication for hand hygiene, indicate the
corresponding information in the first of the numbered opportunity
sections in the column corresponding to the health care provider being
observed.

15. Before initial
patient/environment
contact (BEF-PAT/ENV)
• if the health care provider touches the patient’s
environment and then touches the patient or
• goes directly to touch the patient after having touched the
hospital environment (= any other surface not in the
patient’s environment) or another patient’s environment
• if the health care provider enters the patient’s environment
and touches only the patient’s environment (does not
touch patient) and then leaves the patient’s environment.

16. Before Aseptic Procedure
(BEF-ASP)
• Wound care, dressing change, wound
assessment
• Manipulate an invasive device (e.g.,
priming intravenous infusion set, inserting
spike into opening of IV bag, flushing line,
adjusting intravenous site, administering
medication through IV port, changing IV
tubing).

17. After body fluid exposure
(AFT-BFL)
After contact with blood or blood products,
emptying urinal/catheter bag and suctioning
oral/nasal secretions

18. After patient/patient
environment (AFT-
PAT/ENV)
• health care provider leaves the patient and
his/her environment to go on working in the
hospital environment or with another patient
• health care provider leaves the patient area after
touching objects in the patient environment
(without touching the patient) to go on working
in the hospital environment or with another
patient.

19. Ensure that staff know what you are auditing
Be open and honest about the process
Be clear from the beginning if you will be
using ‘on the spot’ feedback
Share the data regularly
Be consistent!
Tips

20. E.g. HCW enters a room, cleans hands with
alcohol and then immediately performs an
aseptic procedure. This counts as BEF-
PAT/ENV and BEF-ASP
Document whether alcohol or soap and
water was used.
Mark down all opportunities and
type of HH action performed

21. Indicate if gloves were worn and if HH
performed appropriately before and after
Refer to your facility's policy on rings, bracelets
and nails
If auditing is new, consider not focusing on the
timing of duration of HH. Add this in once the
overall process for auditing is running smoothly
Gloves, nails, bracelets, rings,
timing

23. The nurse opens the door, uses alcohol
hand gel enters the room and goes
towards the patient and introduces
herself
The nurse moves the bedside table
The nurse helps the patient to bring out
his arm from under the sheets
Scenario 1

24. Key messages:
• The nurse performs hand hygiene while
approaching the patient environment.
• The nurse handrubs before touching surfaces
and objects. As these are part of patient’s
environment, it is not necessary to perform
hand hygiene again before touching the patient.
• The indication remains “before initial
patient/patient environment contact.”
Scenario 1

25. •The nurse uses alcohol based hand rub in the
corridor
•The nurse is on his way to the room and suddenly
remembers he needs to make a phone call. The
nurse uses the phone in the waiting area (last
contact with health care environment) and then
goes directly into the room towards the patient
•The nurse helps the patient to bring his arm out
from under the sheets
Scenario 2

26. Key messages: After performing hand hygiene in
the corridor (additional action not corresponding
to any recommended indication), the nurse then
touches the phone in the waiting area and thus
potentially contaminates his hand.
The nurse then misses the action before initial
patient/patient environment contact, potentially
contaminating him with those germs
Scenario 2

27. • The nurse enters the room, performs HH and places the
equipment ready for giving an IV medication on the
overbed table
• IMED pump alarms so nurse resets pump
• The nurse moves the overbed table and performs HH
• The nurse cleans the IV port and injects the medication
into the IV port (aseptic procedure)
Scenario 3

28. • Key Messages: The nurse has a first direct
contact with the patient (performs hand
hygiene as indicated) and the patient
environment; she then repeats the hand
hygiene action before the aseptic procedure
to protect the patient from her own
organisms.
Scenario 3

29. • The gloved nurse in the room punctures the patient’s
finger and squeezes drops of blood onto a strip and then
tests with the glucometer
• When the nurse finishes, she places the lancet in the
sharps container and then places the alcohol swab in the
garbage. She then takes off her gloves and places them
into the garbage
• The nurse takes the patient's pulse
Scenario 4

30. • Key messages: Hand hygiene must be performed
immediately after body fluid exposure risk, before
touching either the patient again or any surface and
object within the patient environment or health care
environment, to prevent potential dissemination of
organisms. Any care activity implying contact with
body fluids constitutes a risk because exposure
may not be visible but may have happened.
Scenario 4

31. How to participate?
Alexandru Titeu
Central Measurement Team

32. Patient Safety Metrics - Introduction
Getting Data In
– Data Collection Forms (DCF) – Patient-level
– Worksheets - Numerator and Denominator
– Hand Hygiene Audit – Acute, LTC, Home Care
– Requirements for Faxing
Patient Safety Metrics - Demo
– How to enroll in Hand Hygiene Intervention for all sectors
– How to add and generate the forms
– How to view data and run reports
Agenda

33. Features:
Cloud-based data collection and reporting tool – no cost to
user
Accessible by registered members (email and password)
Available in English and French
Tracks >100 process and outcome measures over 14
interventions
Provides real time reporting and export of data to
CSV/Excel
Roll Up or Drill Down Reports (i.e. Unit Organization
Health Region Province National) with automated
Run Charts
Patient Safety Metrics

34. Getting Data In
Data Collection (Audit) Forms

35. Data Collection (Audit) Forms - DCF
– Patient-level data (de-identified) - daily
– Multiple data elements
– Print form Collect data Fax form
– Automatic roll-up to Measurement
Worksheets
Data Collection Forms

37. Hand Hygiene Audit Tool
so we may contact you
in the event of an error

38. Hand Hygiene Audit Tool
Long-Term Care and Home Care
Acute Care
+ Family caregiver

39. Hand Hygiene Audit Tool
Acute Care

40. Hand Hygiene Audit Tool
Once per HCP

41. Patient-Family HH Data Collection Form
41
Are you collecting
HH observations
from the Pt-Family
Perspective?
Are you collecting
HH observations
in Home Care?
Tell us how in the
‘chat’ box…

42. Enter your Name, Phone Number, and E-mail in the
top-left corner (so we may contact you in the event of
an error)
Enter all elements of the Date (year, month, day) on
all forms
Enter Day as a double digit (e.g. the 3rd should be
entered as 03, with 0 on the top row and 3 on the row
below)
Requirements for faxing DCFs

43. Fax in batches that are 10 pages or less
Fax with NO COVER PAGE
Set fax machine to FINE or SUPERFINE
RESOLUTION
Use a Flatbed (flat glass scanning) fax machine if
possible
Login to PSMetrics one hour after faxing your forms
to verify the data was received successfully
Requirements for faxing DCFs

44. Do not hole punch, fold or spill anything on the form
Do not cross out bubbles if you made a mistake, use the
VOID bubble to exclude wrong sections
Fill in bubble completely (Sharpie is best, pen and pencil
are OK) - do not stack forms because ink may bleed
through the paper
Do not write or make extra markings on the form
Beware of common mistakes!

45. Getting Data In
Measurement Worksheet

46. Measurement Worksheets
– Aggregate data - monthly
– Numerator and Denominator
– Created automatically when you add your
DCFs
Measurement Worksheets

47. Accessing Measurement Worksheet
https://psmetrics.utoronto.ca/metrics/login.aspx

48. Accessing Measurement Worksheet

49. Accessing Measurement Worksheet

50. Entering Data on Msmnt Worksheet

51. Entering Data on Msmnt Worksheet

54. Patient Safety Metrics - Live Demo
54
Patient Safety Metrics
https://psmetrics.utoronto.ca/metrics/login.aspx
Central Measurement Team
Virginia Flintoft & Alexandru Titeu
metrics@saferhealthcarenow.ca

55. STOP! Clean Your Hands Day
Journée ARRÊT! Nettoyez-vous les mains
Register now! /
Inscrivez-vous maintenant!
www.handhygeine.ca
www.hygienedesmains.ca

56. Upcoming calls / Appels à venir
STOP! Clean Your Hands Day: Brief summary of Hand Hygiene Audit Results followed by
‘What’s Your Hand In It’: Pitch to the ‘Dragons’
May 5th, 2014
https://cpsi-icsp.webex.com/cpsi-icsp/j.php?J=965929460
Time:
9:00 -10:30 a.m. PDT /10:00 -11:30 a.m. MDT /11:00 a.m. – 12:30 p.m. CDT /12:00 -1:30 p.m. EDT /1:00 -2:30 p.m. ADT /1:30 -3:00 p.m. NDT
Presentation of Findings from the Canadian Hand Hygiene Audit Event
May 20th, 2014
https://cpsi-icsp.webex.com/cpsi-icsp/j.php?J=963305754
Time:
9:00 -10:00 a.m. PDT /10:00 -11:00 a.m. MDT /11:00 a.m. – 12:00 p.m. CDT /12:00 -1:00 p.m. EDT /1:00 -2:00 p.m. ADT /1:30 -2:30 p.m. NDT
Series of Hand Hygiene Improvement Calls : Date, Time and Topic TBD

57. Questions?

58. Thank You / Merci
Evaluation Poll
Sondage d’évaluation