The mystery of the missing moment: comment to win!
In January, we promoted the 4 Moments for Hand Hygiene – a simple and effective way to ensure safe, quality care and prevent infections in health-care settings. Beginning in March, we’re focusing on the first moment – BEFORE initial patient/patient environment contact.
There’s an interesting statistical trend when it comes to the first moment. On average throughout VCH hand hygiene compliance is 29% lower in the before moment than the after moment (see graph below). We would like to hear from you why you think this is?
Why before?
To protect the client/patient/resident and their environment from harmful germs carried on your hands.
What is before?
Clean your hands when entering a room:
- before touching client/patient/resident
- before touching any object or furniture in the client/patient/resident’s environment
- before putting on gloves
Some examples of patient/patient environment contact may be:
- shaking hands
- helping a patient to move around or get washed
- taking pulse, blood pressure, chest auscultation, or abdominal palpation
- adjusting an IV rate
Weigh in to win!
Use the comment section below to tell us why you think the Before Contact moment gets missed more often, or make a suggestion about how this trend could be corrected, and you could win one of two $25 Visa gift cards. You may comment using an anonymous screen name, but please enter your VCH email address so we can place you in the draw. Your email will not appear with your comment.
Draws will be made April 25, 2016 and winners announced in the April 28 VCH News.
Learn more
For more hand hygiene information and resources, check out B.C.’s guidelines on the Provincial Infection Control Network (PICNet) website or the Hand Hygiene web page on VCH Connect.
Peter
Generally when dealing with biohazards and possible infection, we always think of protecting and cleaning ourselves, and thus are fastidious after possible exposure. Perhaps an idea would be for each of us to consider that we my be the possible carrier of infection, and thus we need to make ‘disinfecting’ ourselves as a first step before each contact with patients and patients’ families. Perhaps coming up with an acronym from a a step by step cleaning process before entering each room/ coming into contact with a paitent would be helpful and something easy to remember for everyone in the organisation.
Devinder
One of the reasons why hand hygiene may be missed prior to patient contact maybe due to becoming too focused on the patient’s request (i.e. requiring pain medication, needing urinal). Even though the urgency in some situations exists (i.e. client is having an active bleed from their IV site) where the nurse may not be able to wait to clean and dry his/her hands with hand sanitizer, and may have to quickly put on gloves to apply pressure to the site, most routine patient contact does allow for clinicians to clean their hands prior to contact. As already mentioned, incorporating hand hygiene into the daily routine for the units will increase clinicians’ compliance with this. Most nurses may clean their hands after leaving another patient’s room and if a call bell rings right away, they may go into the next patient’s room without cleaning their hands again. In addition, if random hand checks using UV light (black light) were conducted, I feel it may cause more awareness among the staff if they were able to “see” the germs on their hands.
Pam
I believe it is because we have just finished washing after being with another patient and the time it takes to wash, dry and put on gloves yet again is very time consuing, meaning having to put on larger gloves as well as hands never get dry that quickly.
Barb
More housekeeping checks! The other day, two sink stations without paper towels. One sink station without soap.
Becca
I believe that missed moment is because after contacting patient’s belongings/leaving the room, we clean our hands and they are therefore “clean” until exiting the next room subconsciously. We are not used to cleaning prior to entering a room unless there are infection control precautions; otherwise, we believe gloves are enough for non-contact precaution rooms, and cleaning is done after.
Cherpi
The ‘presumption’ that we are still ‘clean’ only until we have actually touched and care for someone/things. The mindset has been that for a long time and we just have to keep reminding ourselves and change our practice.
Kristin
I think if we as healthcare staff become more mindful in our day to day and remind ourselves of all the germs that can be on daily objects (phone, charts, pens, etc), we might make more of a concious effort to wash our hands before client care.
Lorenz
Hand hygiene stations and posters are not prevalent. It is easy for healthcare workers to have the automatic practice of before and after practice of hand hygiene but for the general public, they need reminders.
Jennifer Seslija
Washing hands before engaging with a client is often forgotten because we don’t think our hands are dirty until after we have touched a client. Maybe if we could visualize the germs on our hands before we engage in client care, we could influence change in our habits and how we should be providing care.
Leanna Ritchie
I think we falsely think our hands are not dirty if we have not come directly from caring for another patient. An example would be if we are charting and go to answer a call bell, or after taking medications out of the omnicell. We forget that the chart, nursing station or omnicell are actually dirty.
New, innovative (no idea what that could be), visual/audible reminders in the nursing stations or by the omnicells may be helpful.
Karen
The before moment can be missed because sometimes healthcare staff may feel rushed to attend to a client/patient right away. Sometimes it can be an environmental barrier such as the sanitizer being obstructed from view, hard to reach, inconveniently placed, or even empty. For staff that have skin sensitivity to alcohol-based sanitizers, there may not be enough sinks or inconveniently placed sinks. The before moment is crucial to protecting patients and their environments from anything harmful that can be transmitted via hands (even if they appear clean!) so it’s important to make a habit out of cleaning hands before contact until it becomes an automatic practice. It’s also important to address any barriers that can prevent hand hygiene (having more sanitizers available, relocating them to more convenient spots etc).
Karen Mayo
I know where I work, they exit one room and wash their hands as they exit and don’t feel they need to wash to go into the next room. Often they have picked up a pen and documented and then entered the next room without another hand wash.
Brittany Nelson
Increasing workload and decreasing staff levels.
I think that this moment gets missed more often due to high paced clinics / hospitals and quick changes between patients. ie. leaving one patients bedside to rush to the next.
Lori Nobes
As indicated in the poster, the “before” moment is critical to keeping our patients and ourselves healthy. I think it gets missed because we think our hands need cleaning only after touching a patient/items in the room. This requires repeated practice so that it is an automatic response that we clean our hands before and after patient contact.
Zori Kaneva
I work at the Diamond Health Care Centre and there are not enough hand sanitizer despensers available. There should be a hand sanitizer beside each exam room and patient room, so that health care workers will not forget to disinfect their hands before making a contact with a patient. Also, there should be sanitizers at reception desks.
Sheila Browning, Hand Hygiene Program
Thanks for your comment Zori – I will follow up on hand sanitizers outside each exam room (I do believe there is one inside every exam room). We now have desk top brackets for hand sanitizer available free of charge, I’d be happy to supply them for the recptions desks in the Diamond Health Care Centre.
Tanya
Forgetfulness, lack of knowledge, language barrier, being on autopilot or focused on another task at hand and lacking attention to detail. Practice makes perfect. Perhaps it might be helpful to people to have visual or audio reminders to create positive habits to remember hand hygiene.
Sheila Browning, Hand Hygiene Program
Thanks Tanya – a great example of the many different distractions staff deal with on a daily basis. There is some very interesting research going on now – In one trial, the researchers positioned a picture of a man’s intense staring eyes above the alcohol hand gel dispenser outside a patient room. Hand hygiene compliance increased 33.3 percent after the addition of the picture. Could be an interesting experiment to try on a unit somewhere in VCH.
John Mclean
I think people are either distracted by other clinicians, family, staff etc or they are distracted by thinking about how to enter the patient’s space prepared with appropriate case details/answers.
Answer: distraction
janice doiron
I believe it is because everyone is so busy and they forget to think “what would I want” if we all thought about how we would like to be handled in the same situation we would wash our hands or go that extra mile.
Sheila Browning, Hand Hygiene Program
Thanks for your great comment Janice. Great idea for our next campaign refresh – “What would I want?” for myself or my loved ones.
Harvey Bristol
rushing.
stefanie leblanc
The moment is missed because we assume that gloves are good enough, or perhaps we feel dirtier immediately after having touched someone than we do before – having forgotten where else we have been recently. It could be a time crunch, also.
Julian Jamieson
Hi
I believe that before contact can be missed because a member has not pre-programmed into their daily routine that as soon as they enter a VCH site to sanitize there hands. Followed by additional hand cleaning before and after patient contact. Once you make it part of your routine then it is simple to remember (similar to the instructions we all remember for safety on a aircraft). Keep the message simple and the same across all sites, all HA’s. The other miss could be that a member just cleaned their hands leaving one patient care room/setting and does not clean entering the new setting because they just cleaned their hands.
Sheila Browning, Hand Hygiene Program
Thanks for your comments Julian. I completely agree that good hand hygiene must be routine for everyone, no matter if they are a staff member, the patient, or a visitor – everyone needs to do their part. To clarify your last point, if a staff member has just cleaned their hands upon leaving one patient care room/setting and goes directly to the next patient care room/setting without touching anything – their hands are clean and it is not necessary for them to clean their hands again (for auditing purposes).