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Rehab unit is hands-down winner in war on germs
Chocolate bars, pizza parties are sweet rewards
Rehab usually isn’t considered the most glamorous unit in the hospital. Emergency department, intensive care unit (ICU), obstetrics — they get all the press.
But the rehab unit at the University of Utah Hospital in Salt Lake City isn’t going to take it anymore. Last year, they declared war on the rest of the hospital, and won — hands down — or hands clean, as the case may be.
In the hospital’s "War on Germs," the rehab unit continues to smoke the medical-surgical units in the quarterly competition to see which unit can get the most staff to wash their hands each time they enter a patient room. Rehab has won each of the three quarterly competitions held so far.
The hospital’s infection control committee decided about three years ago that it needed to increase hand hygiene, says Barbara Mooney, RN, BSN, CIC, coordinator of hospital epidemiology. International data show hand washing in hospitals worldwide happens only about 30% of the time. Utah set a 60% threshold and now is fighting toward a goal of 80% to 90%. While Mooney will not share the exact numbers reached, she says the hospital has tripled its hand-hygiene compliance numbers so far.
At about the same time the hospital was looking at ways to increase compliance, the university developed a hand sanitizer called GelSan; it has a 64% alcohol base that kills a variety of organisms while preventing chapped hands.
The hospital started with a one-year project comparing the use of GelSan in certain units to other units that used soap and water. "We showed an increase in hand hygiene and an improvement in the transmission of organisms, so we went housewide with the GelSan," Mooney says.
Besides just plain forgetting to wash, one of the reasons hospital staff avoid hand washing is it hurts their hands to scrub them with soap and water so many times a day. GelSan moisturizes hands and prevents chapping. Also, getting a squirt from the dispenser as they enter the patient’s room takes less time than scrubbing at the sink, she adds.
The hospital uses three observers who work about 10 hours each per month to spy on the units and record whether staff are washing at each patient room. The program has logged 40,000 observations in the computer system. For the first year, the hospital also took stool samples from patients on admission and at discharge to test for the spread of organisms. "Now we’re looking at the ebb and flow of organisms throughout the hospital. We’ve not had the same blips of organisms that we had before," Mooney says.
But the real reason the hand-hygiene program is working, says Sunny Vance-Lauritzen, MS, SLP, CCC, director of the neuro/rehab service line, is food. When staff members are observed using the GelSan or washing their hands, they’re given a chocolate bar with a wrapper that reads "Caught in the Act." The wrappers can be turned in for a monthly drawing for a $100 gift certificate. And the unit that wins the quarterly competitions gets a pizza party.
"Every time they win the war on germs, they get to choose their reward and recognition. For rehab nurses, food always works," Vance-Lauritzen says. "As a CARF surveyor, I’ve never seen anything like that out there. For rehab to win every quarter is remarkable."
It’s particularly easy to forget to wash between patients on the rehab unit, because there still are some four-patient rooms there, adds Keri Burton, RN, BSN, nurse manager for the rehab unit.
"It’s imperative to wash between patients, not just rooms," she says. "This has been a real eye-opener for the staff. We didn’t realize how often we could share germs between patients. It is really cumbersome to go to the sink between all four patients in the room."
The GelSan dispenser makes that easier, Burton explains, and the hand-hygiene reminder signs all over the unit make it hard to forget. "The patients’ families are washing, too; and the patients will remind you now if you forget to GelSan."
The unit numbers are divided into percentages for nurses, physicians, and other staff, such as therapists. "Our weakness has been in the physician area, so our staff give them a hard time," she continues. "They say, You’re bringing our score down.’ I show the scores to the medical director so they’ll see they are our low score. But it’s become a game for the whole staff. Everyone, even the therapists, are trying to make sure I catch them so they can get a chocolate bar."
Vance-Lauritzen says the program, besides engendering the obvious benefits of improved hygiene and infection control, has had another result in rehab: It’s created a real team spirit.
"It’s been great for the nurses. Rehab isn’t always as glamorous as working in an ICU," she points out. "Our rehab nurses take a lot of pride in what they do. It’s just one more bee in their bonnet. It made them feel good about themselves as a specialty in the hospital.
"As the day goes through, we’re in and out of patient rooms; and I think we forget how important hand washing is. I don’t think we always in a therapy arena think about washing our hands. It’s as important on a rehab unit as it is in an ICU, because we have people on respirators; we have wounds. It’s every bit as important, but we just didn’t think about it on that level."
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