Improving hand hygiene performance in Victoria – Beyond the national hand hygiene initiative

Improving hand hygiene performance in Victoria – Beyond the national hand hygiene initiative

130 Conclusion: Although the WHO has recommended that patients have a role in encouraging hand hygiene as a means of preventing infection, patient eng...

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130 Conclusion: Although the WHO has recommended that patients have a role in encouraging hand hygiene as a means of preventing infection, patient engagement remains an underused method. Deep-seated public fears about individual vulnerabilities, still need to be addressed.

IMPLEMENTATION OF A ‘RED AND GREEN’ CLEANING PROGRAM FOR ISOLATION ROOM DISCHARGES Sue Flockhart 1, Catrice Grahame 2, Allison Hodge 3 Ballarat Health Services, Redan, Australia 2 Ballarat Health Services, Miners Rest, Australia 3 Ballarat Health Services, Ballarat North, Australia

Abstracts high-risk patient cohort. This leads the project towards possible introduction of a high-risk maintenance bundle for this patient cohort.

IMPLEMENTING THE CLINICAL EXCELLENCE COMMISSION (CEC) CRITERIA LEAD URINARY CATHETER REMOVAL PROTOCOL IN A MAJOR RURAL FACILITY Suzanne Lovell-smart Orange Health Service, Orange, Australia

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Introduction: The introduction of the National Safety and Quality Health Service Standards in 2012, and an escalating number of isolation room discharge cleans prompted Infection Prevention and Control to review its isolation room cleaning program, and found a major review of both practice and product was warranted. Methods: Reviewing the isolation room discharge cleaning programs strengths, weaknesses, opportunities and threats presented areas for improvement. These included a colour coded cleaning program, a change of cleaning product, an education program and the addition of a visual inspection audit tool utilising UV gel. This program was implemented in the acute care areas with a train-the-trainer program of core cleaning staff, whilst nursing and support staff received education on the program. Results: Prior to the revised program there were up to 130 isolation cleans per month. Post implementation there was an initial decrease of 30% however this has increased to around 20% due to seasonal illnesses. Utilising the UV gel as part of a visual inspection audit has improved cleaning compliance from 40% to an average of 81%. Conclusion: Since the implementation of the revised isolation room discharge cleaning program, it has been embraced by all staff and is now to be introduced into other areas of the health service. It was important to give ownership of this project to the cleaning staff and once they knew why they were cleaning and how to clean it provided them with an improved understanding of the role the environment plays in the transference of infection.

IMPLEMENTATION OF A CENTRAL VENOUS ACCESS DEVICE (CVAD) MAINTENANCE BUNDLE TO DECREASE THE RATE OF ORGANISATION WIDE CVAD RELATED INFECTIONS Karen Mardegan, Dr1,2, Kerrie Curtis 1, Sam Radford, Dr1,3, Donna Cameron 1, Lindsay Grayson, Professor1,3 1 Austin Health, Heidleberg, Australia 2 La Trobe University, Bundoora, Australia 3 Melbourne University, Melbourne, Australia Introduction: A plethora of studies in recent years have been published detailing the implementation of Central Venous Catheter (CVC) Insertion Bundles of care. Study aims and results showed a decrease in central line infection rates. Two aspects make this project different; the introduction of a CVAD Maintenance Bundle and the inclusion of all Central Venous Access Devices (CVADs) across the organisation. Methods: Evaluation of practice, products, maintenance documentation and CVAD policies compared to best practice evidence was led by a multidisciplinary Steering Committee. Subsequently a CVAD Maintenance Bundle was formalised incorporating new products (dressings and access valves), reinforcement of current practices (hand hygiene, daily review for necessity, aseptic non touch technique and flushing practices) and supported by revised hospital policies. Organisation wide communication and education preceded introduction of all bundle elements in May 2015. Results: Review of maintenance bundle practices in April 2016 revealed improvement across all areas; 93% dressings intact (24% improvement), 89% dressings in good condition (72% previously), 96% clean access valves (33% improvement), 83% improved documentation (47% previously). Staph aureus bacteraemia rates have decreased from 1-2 per month in 2014 to 1 per month in the haematology/transplantation unit and 0 in the remainder of the organisation. Conclusion: The introduction of the CVAD Maintenance Bundle appears to have had a beneficial impact on consolidating evidence based practices. Indications suggest an improvement in CVAD infection rates except in one

Orange Health Service was invited to be one of 8 NSW clinical units to participate in the pilot of the new protocol as the CEC had reviewed previous indwelling urinary catheter in elective hip/knee arthroplasty. Unnecessary use or prolonged catheterisation is a main cause of catheter associated urinary tract infections, over usage of antibiotics and reduction of early mobilisation. Many of the decisions are dependent on the patients’ medical officer who might not be available, unaware catheter remains insitu, does not write removal orders or writes removal on mobilisation. The pilot period was over 5 months Pre-implementation - data & survey collection Implementation - Education & training Post implementation - data collection, survey and review. For the pilot to be a success it required team links, leadership, cultural and behaviour change in the clinical environment. Auditing, reviews of change practice helps sustain change but also a cause for celebration of new beginnings. Empowerment of clinical staff to make informed decisions and actions regarding the early removal of IDCs, which led to a reduction of Hospital acquired CAUTI’s The involvement in this pilot project led to the invitation to participate in the HETI eLearning Program: ’Indwelling Urinary Catheter Insertion’

IMPROVING HAND HYGIENE PERFORMANCE IN VICTORIA e BEYOND THE NATIONAL HAND HYGIENE INITIATIVE Jennifer Bradford, Andrew Stewardson, Dr, Lindsay Grayson, Professor Hand Hygiene Australia, 145 Studley Rd, Heidelberg, Australia Introduction: This project was initiated to optimise efficiency of hand hygiene (HH) audits, improve access to education resources, and review implementation of the National Hand Hygiene Initiative (NHHI) in Victorian public health services (VPHS). Methods: Workshops were held to distribute mobile devices loaded with resources for HH auditing and education to VPHS. A review visit was conducted at each VPHS, comprising a standardised interview and side-byside HH auditing. Questions addressed system change, healthcare worker education, auditing, performance feedback and safety climate. VPHS received recommendations and were requested to complete a final evaluation. Results: Seven workshops were held to distribute 117 mobile devices to 84 VPHS. Overall 62/85(73%) VPHS completed a project evaluation. Sixty percent (37/62) health services did not use a mobile device for HH auditing before the project. Of these, 84%(31/37) used mobile devices for auditing after the project. Mobile devices reduced auditing time by up to 50% compared with paper-based audits. All VPHS programs were consistent with the NHHI. Areas for improvement included opportunities for more interactive education, frontline ownership and targeting of specific clinical groups and departments. Most respondents (81% [48/59]) indicated that changes had been either planned or implemented on the basis of recommendations from their review visit. We identified local innovations that could be disseminated to other VPHS. Conclusion: Use of mobile devices improves efficiency of HH auditing. Innovations and key components of successful programs will be shared to facilitate improvement in HH practices and outcomes may be used to guide HH promotion in the future.

IMPROVING UPTAKE OF NEW CLEANING PRACTICES USING IMPLEMENTATION SCIENCE Michelle Allen 1,2, Kate Halton, Dr1,2, Lisa Hall, Dr1,2, Nicholas Graves, Prof1,2,3 1 Queensland University of Technology, Kelvin Grove, Australia