Getting tough on hand hygiene has never been so fun

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Getting tough on hand hygiene has never been so fun

Toronto, July 15, 2016

By James Wysotski

Jesse Potts performs hand hygiene during a Tough Scrubber session
Jesse Potts, a clinical assistant in the Cardiovascular Intensive Care Unit, performs hand hygiene during a Tough Scrubber session. (Photo by Katie Cooper)

The difference between a Tough Mudder and a Tough Scrubber isn’t as vast as one might think.

The former, a military-style obstacle course, revolves around teamwork while testing mental and physical strength. Participants in the latter – a St. Michael’s Hospital initiative to improve hand hygiene – are also tested, and they, too, have learned that everyone wins by helping colleagues succeed.

Tough Scrubber, the brainchild of the Heart and Vascular Program’s Quality and Safety Leader Group, begins with staff taking a five-question test requiring them to read about patient interactions and identify if hand hygiene is necessary.

“The questions are challenging,” said Laura Shapiro, an occupational therapist and co-chair of the group. “They give staff the opportunity to say ‘What's Moment 1 again? What's Moment 4?’ It was also a good refresher for Accreditation.”

Next, participants go through mock scenarios featuring co-workers as “patients.” Again, the task is to perform hand hygiene at the proper moments while touching medications, transferring patients, giving out water or handling scanners and patient wristbands. Despite the informal setting, the realistic situations inspire true learning.

Proof comes a month later when participants redo the test to see if they retained the knowledge. Early data suggests they do. In January, Infection Prevention and Control’s Moment 1 (before patient contact) compliance rates for Cardiology and the Cardiovascular Intensive Care Unit were 40 and 50 per cent, respectively. Following Tough Scrubber’s creation in February, the March data jumped to 74 and 69 per cent. Of course, Tough Scrubber cannot take all the credit; other hand hygiene Quality initiatives certainly helped achieve the increase, said Shapiro.

Did you know?
The Quality and Safety Leader Group is a team of highly motivated and innovative front-line staff representing the units of the Heart and Vascular Program. This committed group has demonstrated during the past several years the impact of when front-line staff is supported to take the lead in Quality initiatives such as hand hygiene.

The Heart and Vascular Program has completed all six of its planned Tough Scrubber sessions, which featured different scenarios geared toward each area of its practice, including the CVICU, Cardiac Intensive Care Unit, Cardiology and Cardiovascular Surgery. Approximately 50 staff participated. Infection Prevention and Control is likely to run Tough Scrubber sessions next year in other units around the hospital with scenarios tailored to their disciplines, said auditor Cameron Thomas.

“There have been a lot of learning moments about what constitutes the patient environment and if you should wash your hands before or after touching things such as scanners or whiteboards,” said Shapiro. “Some even overwash their hands. We give them live feedback, so we actually audit them while they're doing it.”

Even with up to 10 quality and safety leaders watching, Shapiro said they’ve done well, adding that the pressure caused by their presence mirrors the stresses of day-to-day work.

While the focus is on promoting patient care and safety, the emphasis is on fun. And staff feedback has been really positive.

“It gives them a platform to ask questions about hand hygiene,” said Shapiro. “People are a lot more engaged and the topic has become a lot more approachable.”

'Tough Scrubber' Hand Hygiene Knowledge Quiz

Scroll down to the bottom of the page for the answers.

  1. You perform hand hygiene (HH) and push your WOW into the patient’s room. After touching the patient, you push the WOW out of the room and perform hand hygiene at the door on your way out.
    1. You didn't need to perform HH
    2. Moment 1 was missed
    3. Moment 4 was missed
    4. Moment 1 and Moment 4 were missed

  2. A patient is in the hallway waiting to be transported to some tests. You finish charting at the nursing station then walk over to say hello, and rest your hand on their stretcher.
    1. Moment 1 was missed
    2. Moment 4 was missed
    3. Moment 1 and Moment 4 were missed
    4. You are not in the patient room, no moments were missed

  3. You set up your patient’s medication on your WOW. You perform hand hygiene, pick up the medications and scanner off the table and enter the patient environment to assist your patient.
    1. Moment 1 was missed
    2. Moment 1 was completed

  4. In shared rooms, the patient curtain is:
    1. Patient environment
    2. External environment
    3. Neutral

  5. The scanner is:
    1. Patient environment
    2. External environment
    3. Neutral

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

Answers: 1 - d, 2 - a, 3 - b, 4 - c, 5 - c

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