Monday, November 28, 2011
North Shore University Hospital in Manhasset, N.Y. is the first hospital to adopt a new video monitoring technology to track hand-washing. The video monitor technology is made a by Arrowsight. The technology relies on a network of sensors that monitor entrance activity around doors and a series of cameras mounted on ceilings above sinks and hand sanitizing stations both in and outside patient rooms. Arrowsight employees monitor the footage to track whether staff wash their hands within 10 seconds of passing through the door.
The rates are published daily on large L.E.D. displays in the hallways and serve as a constant reminder to the staff. The nurse manager also gets e-mail messages throughout the day with detailed information about hand-washing rates.
The new video monitoring technology was implemented in the surgical and medical intensive care units (ICUs). ICUs typically have the lowest hand-washing rates because the staff there are the most harried due to large volume of patients and that most patients in ICUs are in serious medical conditions. Since adopting the technology three years ago, both ICUs have achieved and sustained better results than before. The medical ICU in particular, improved its hand-washing rates from 6.5% three years ago to over 80%.
Read the article in The New York Times
Abstract to North Shore's study published in Clinical Infectious Diseases
Thursday, September 22, 2011
Monday, August 29, 2011
Wednesday, August 10, 2011
An influenza vaccination campaign that included a face-mask mandate for all unvaccinated health care workers (HCWs) led to a vaccination compliance rate of 95 percent at Geisinger Medical Centers in Pennsylvania during 2009, researchers report in Infection Control and Hospital Epidemiology. "Establishing a tough and enforceable requirement that any unvaccinated individuals wear a mask for the entire flu season not only produced the vaccination compliance rates we wanted, but avoided unnecessary legal challenges and inspired an amazing amount of team spirit," said Dr. Lisa M. Esolen of Geisinger Health System. The analysis of the health system's vaccination campaign, implemented during the 2009-2010 flu season, included 12,363 HCWs employed at Geisinger Health System throughout the state. Unvaccinated employees were instructed to wear a surgical mask when they were within six feet of a patient during their shift. The campaign also included a vaccination effort that included increased vaccination hours, vaccination stations at HCW entrances and outside the cafeteria, and recruiting 150 "flu team captains" to decentralize vaccine supplies with vaccination kits. Compared with vaccination compliance rates of 47 percent in 2007 and 61 percent in 2008, vaccination compliance rates among HCWs were 95 percent during 2009 and 92 percent during 2010.
From "Face-Mask Mandate Improved Flu Vaccination Rates Among HCWs"
Pediatric Supersite (06/22/2011)
Tuesday, July 12, 2011
A well-known public health expert is often asked to be a keynote speaker at infection management seminars. I happened to hear him present at two different infection control gatherings about a year apart. They were both emotional speeches about the modern day dangers cause us all to face. During the first speech he talked about how he lay awake nights worrying about his daughters and their survival chances in a world of anthrax. In the next speech he talked about how he lay awake nights worrying about his daughters and their survival chances in an age of Avian Flu. Clearly he was talking about the disastrous infection of the moment.
So what’s wrong with this picture? Link to the following for the answer: http://2.bp.blogspot.com/_a9OgLbIsBns/TMpEWB-eabI/AAAAAAAAALg/gaQHkVlSf1o/s1600/sky+falling+in+cartoon.jpg.
I believe that the public and healthcare providers are suffering from a disaster fatigue. There are too many infections to worry about them all. Worse yet, many of the dire scenarios painted by the media (with the help of some public health officials) have not occurred. It is becoming more and more difficult to know what is real and what to do about it
At the same time the public has come to view health care facilities as death houses where patients are discharged in worse condition than when they were admitted. Public reporting has reinforced this perception. I think that the fact that reporting is legally required is more frightening than the actual contents of the reports. If it must be reported, it must be really bad.
Certainly, there are serious infections occurring in various places throughout the world. The recent E. coli outbreak was a sobering event. Our job as IPs is to place these events in perspective and to help people understand their personal risks of contracting a serious infectious disease.
When everyone was worried about avian flu I was asked to make several presentations about it. I used humor to try to deflate the audience’s anxiety. I showed pictures of houses built above duck ponds and asked “Does this look like your house?”
I showed pictures of people taking dead geese to market on the backs of mopeds, etc.
I think my efforts were successful in bringing listeners back to reality where they could plan rationally.
The humor was not intended to make light of the issue. Rather it was intended to reduce the level of anxiety in the audience so that we could discuss the actual threats and possible responses.
I think it is important to use a variety of techniques balance the scales of concern. In some cases stories about personal concerns are appropriate. But we must consider ourselves to be Panic Preventionists as well as Infection Preventionists. This is no easy challenge to bring people back to earthly sights when everyone else is screaming “Watch out for the birds”!
Monday, June 13, 2011
While APIC encourages the public to use the information to initiate conversations with healthcare providers to learn more about a hospital’s infection prevention program, the organization emphasizes that the public should not base their decisions and opinions solely on this report.
Thursday, June 9, 2011
IPs spend a lot of time monitoring and educating about handwashing. There are continuous debates about what the consequences should be for staff who are “caught” not washing their hands. One question that rarely is raised in Infection Control Committee meetings is whether there is an upper limit beyond which hand hygiene will no longer play a major role in HAI prevention. The answer can have profound effects on the amount of time and energy devoted to this one particular part of the IP role.
Two recent articles have questioned the relationship between increasing handwashing compliance and reduction of health care infections. Biggs, Shepherd and Kerr (2008) performed a mathematical analysis of the transmission of Staph by healthcare workers’ hands that became contaminated by patient contact. They concluded that a compliance levels (or imperfect hand hygiene) <50% were sufficient to stop outbreaks. They also concluded that the rate of increase in hand hygiene compliance was not associated with a similar decrease in infection transmission
Silvestri, Petros, Sarginson, et al (2005) conducted a literature review of 9 studies that looked at the relationship between hand hygiene compliance levels and actual infection rates. They concluded that [poor] handwashing can only account for 40% of transmission in intensive care units.
Why do these studies make sense in a time when hand washing is the first commandment of health care delivery? Both the literature and everyday observation provide some answers. First, glove use is becoming a universal practice. There are few studies that test how much hand contamination occurs with the use of gloves. Second, think of all of the environmental surfaces and healthcare equipment becomes contaminated and is used without cleaning. Stethoscopes, phones (both patient and clinician), bath basins, computer screens and on and on have been found to be contaminated. How effective are clean and gloved hands if contaminated equipment is used between patients without cleaning in between. I recently conducted a study in which we found that pens became contaminated within a single work shift. How many staff take pens into patients rooms, mark dressings and put the pen back into a pocket?
I think the time has come to take a harder look at housekeeping surfaces. I have found that most housekeepers want to do a good job but are hampered by a workload that allows only the most cursory of cleaning. It is about time that we stopped using precious resources on hand hygiene compliance and use them to provide more housekeepers with better equipment.
Beggs, C.B, Shepherd, S.J., and Kerr, K.G. (2008). Increasing the frequency of
handwashing by healthcare workers does not lead to commensurate reductions
in staphylococcal infections in a hospital ward. British Medical Journal of
Infectious Disease,8, 114. Available at: http:/www.biomedcentral.com/1471-
Silvestri, L., Petros, A.J., Sarginson, R.E., de la Cal, M.A.,Murray, A.E. and Saene, H.K.
(2005). Handwashing in the intensive care unit: a big measure with modest effects.
Journal of Hospital Infections, 59(3), 172 – 179.