What can possibly go wrong? Don't ask

Checklist, teaching tool can help keep it simple

By Patti Grant, RN, BSN, MS, CIC
Infection Preventionist, Dallas

Your infection prevention and control program is textbook perfect. You have verified that each little nuance of the Centers for Medicare & Medicaid Conditions of Participation, The Joint Commission accreditation requirements, and your state licensing rules, are covered in policy, procedure, and program(s). You can fluidly cross-reference the pieces and are confident about accessing requested information quickly. Most definitely, you are ready. So what can go wrong during any of the multiple surveys you'll experience?

If you've been in infection prevention and control (IP&C) for any length of time:

a) you've already learned not to ask that question; because

b) what can go wrong will; and,

c) that something will be painfully obvious and outrageously avoidable.

If you are wondering if there is sarcasm in the above description your imagination is not working overtime — you are sensing exposure to a uniform disappointment of more than just a few of your IP&C colleagues. Let's face it, we do this full time and most of us do IP&C beyond the required 40-hour work week. Yet during formal environmental rounds and/or while walking through the facility to a meeting, obvious and avoidable breeches in IP&C basics might be observed. For example:

  • A housekeeping cart pushed up against the cart holding the lunch trays waiting to be delivered to patients (guidance: separation of clean and dirty)
  • Using a clean Zip-Locked biohazard bag to deliver ice to the patient bedside to freshen water pitchers (guidance: signage dictates practice)
  • Clean linen stacked on a rolling cart to be delivered to patient rooms without a sheet covering it (guidance: protect clean linen from the environment)

Why don't health care workers see and avoid these contradictions in real time? The answer is as obvious as the challenges we face: IP&C is not their only responsibility. They are focusing on getting the lunch trays to the patient while still hot, keeping the ice clean while avoiding cross-contamination during transfer, and getting linens to the bedside in an efficient manner. We notice simple red flags immediately, yet, our advanced IP&C training is not required to see and correct these everyday IP&C concerns.

Too often I've seen protracted, albeit textbook-perfect, assessment forms given to bedside staff to complete related to infection prevention. This type of detailed tool should be used by those who do IP&C as their chosen profession, not by bedside staff who also are incorporating safe medication administration, environment of care safety, and correct application of the myriad evidence-based practices to optimize good outcomes.

After about 20 years as an infection preventionist I've come to believe that 'less is better' when it comes to messaging to those that work at the bedside. IP&C is not their sole mission, so we must pick and choose the barest of IP&C practices to emphasize. Not easy decisions, yet minimize we must, because too much information complicates the bare-bones messaging setting us up for failure through over saturation.

Aside from continuous hand hygiene compliance we must determine, based on the culture and services provided at our health care facility, what are the 'drop-dead' minimums that must be in place at all times. Once you've decided on that list — and keep it to one page — provide a supplemental document as a teaching tool that includes the rationale for each IP&C component. There are no secrets here: provide the check-off and rationale (the why teaching) documents together. These two documents are you without your physical presence. I have a generic one-page check-off list and supplemental teaching (rationale) document that has served me well over the years. (See charts.)

Report back compliance on tool completion as part of your annual program goals. Your part is to provide real-time feedback with problems reported and require a time-driven action plan on their end to address deficiencies. When finance did this, they answered that "PPE" meant "pay period ending." Obviously, I had some teaching to do!