Becker's Clinical Quality & Infection Control

50 INFECTION CONTROL & PATIENT SAFETY Safety Stand-Down: How Borrowing a Military Practice Boosted This Hospital's Hand Hygiene Compliance to 94% By Heather Punke N ationwide Children's Hospital in Columbus, Ohio, was strug- gling with low hand hygiene compliance rates until it took a page out of the military's book and implemented a safety stand-down, ceasing nonessential hospital activities on all units to discuss action plans to improve hand hygiene. e hospital detailed its story in the Journal of Patient Safety. e issue dated back to 2010 when the hospital saw a spike in health- care-associated infections, which spurred a renewed focus on hand hygiene. Covert observation found the hospital's compliance rate was roughly 65 percent. Aer improving healthcare workers' access to hand sanitizer, the hospital hosted a hand hygiene-focused leadership safety summit, attended by all physician section/department chiefs, nurse managers and ancillary department directors. ere, executives discussed the importance of hand hygiene and helped leaders develop an action plan for their unit to improve compliance. e summit also prepared leaders for the upcoming safety stand-down — a term borrowed from the military in which action ceases so senior leaders can talk to front-line workers to discuss safety issues. At the hospital, this meant every department and medical staff section stopped nonessential work to discuss how to improve hand hygiene on that unit. "e attention and 'big splash' associated with stopping all nonessen- tial clinical activity captured the hospital staff 's attention and made it clear that this was important to everyone," according to the study. Other hospitalwide elements of the improvement plan included: • Department or section heads whose sections were less than 90 percent compliant would have to meet with the CNO or CMO to discuss performance. • Any hospital personnel who was found to be noncompliant with hand hygiene regulations would need to meet face-to-face with the CNO or CMO on first and second offence. On third offence, a note would go in their personnel file. Aer the safety stand-down, hand hygiene compliance rose from less than 60 percent to 94 percent, a statistically significant increase. And, with just two exceptions, overall hand hygiene compliance has been above 90 percent for roughly three and a half years, according to the study. "is program can be easily implemented, costs little, and is relatively nonpunitive," the study concludes. "We suggest that other organiza- tions still struggling to achieve high levels of hand hygiene compliance can use this relatively simple technique to improve their results." n 9-Step Infection Prevention Bundle Halves Spine Surgery SSIs By Heather Punke After a hospital instituted a nine-part infection prevention bundle for spine surgery, surgical site infections fell 50 percent, while case costs also fell, according to a study in JAMA Surgery. Researchers compared SSI rates and cost per case for patients undergoing discectomy, decompression, aug- mentation or fusion of the spine both before and after the nine-part bundle was implemented. The bundle included the following components: 1. Screening for Staphylococcus aureus colonization and subsequent decolonization 2. Patients bathing themselves with chlorhexidine gluconate 3. Patients using chlorhexidine gluconate wipes 4. Optimizing storage of operating room supplies 5. Using a preoperative antibiotic administration algorithm 6. Training staff on betadine scrub and paint 7. Using vancomycin in the wound for instrumented cases 8. Mobilizing the patient early after surgery 9. Checking wounds at two and six weeks post-surgery Implementation of the bundle was linked with a 50 percent decline in SSIs as well as an $866 cost reduction per case, which can translate to roughly an $880 million reduction nationally, given the national volume of spine surgery, the authors wrote. "These data suggest that appropriate implementation of an infection prevention bundle can reduce unnecessary harm and expenditures, translating to a clear increase in value," the study concludes. n

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