STOP! Wash Your Hands

By Peter Laird, MD

Inadequate infection control practices remains the single largest preventable source of dialysis related complications by many reports. Sadly, the culture of overlooking basic hand washing, changing gloves and proper cleaning of the dialysis machine is prevalent in every dialysis unit I have dialyzed (9 in 7 different states).  The lessons learned in the ICU preventing blood borne infections with central line catheters by a simple check list where health care associated infections (HAI) have been essentially eliminated should become the model of care in dialysis units.

The World Health Organization (WHO) is now sponsoring the Clean Care is Safer Care initiative which promotes the annual wash your hands day events now ongoing in Canada, but apparently it has yet to catch on here in the United States.

STOP! Clean Your Hands Day

The Canadian Patient Safety Institute (CPSI) launched a national hand hygiene campaign in 2007 under the theme “STOP! Clean your hands”. CPSI is working on this initiative with the Community and Hospital Infection Control Association–Canada, the Canadian Council on Health Services Accreditation and the Public Health Agency of Canada.

A simply mental checklist is also available to remind health care workers when they must wash their hands to prevent HAI's from the WHO.  Simply applying these simple concepts could help prevent thousands of dialysis center acquired infections every year. It is time to put this life saving knowledge to work and change our cultures of death in our American dialysis centers.

My 5 Moments for Hand Hygiene

The My 5 Moments for Hand Hygiene approach defines the key moments when health-care workers should perform hand hygiene.

This evidence-based, field-tested, user-centred approach is designed to be easy to learn, logical and applicable in a wide range of settings.

This approach recommends health-care workers to clean their hands

• before touching a patient,
  
• before clean/aseptic procedures,
• after body fluid exposure/risk,
• after touching a patient, and
• after touching patient surroundings.

 

 

 

 

 

Comments

[roberta mikles]

Peter, you are right about staff overlooking basic practices. For instance, in my review of 25 surveys conducted in California, from Jan - Aug 2010 (recertification surveys) 23 had deficiencies cited in infection control, and a few facilities had Conditions NOT met in infection control. Perhaps a check list to remind staff what they need to do, e.g. Did you wash your hands before putting on gloves, after touching the machine before cannulating, etc.etc. It is truly sad that facilities continue to be cited for the most basic of basic infection control practices. When facilities have not been inspected in over 5 years, some more, we must ask 'what practices, or lack thereof, were taking place in the unit? Further, it is my opinion, that cited deficiencies should have been noted by facility management staff. So, one must further ask, "How long have these incorrect practices been happening?" I have to think to myself and wonder if staff are being adequately trained and if they have a clear understanding of negative outcomes that patients can incur due to their (staff) not implementing correct practices. Of course, staff can also bring these nasty germs home to their families. I observed, more than once, or twice, staff NOT implementing safe practices, when, they had time, were not rushed, and were sufficiently staffed. Again, as I have stated, over and over, if there is appropriate unit level supervision we would not be seeing many of these deficiencies. What is of greater concern is that of patients receiving another patient's dialzyer..another infection control problem. I am not sure what it will take for staff to understand the importance of the most basic practices.. maybe it will take one of them, or a loved one, to acquire a preventable infection before they realize the importance.
My opnions are a result of reviewing of surveys and talking with patients and staff. Not to get into the reprisal for reminding staff to wash their hands. I continue to have patient communicate with me stating there is a fear to speak out.. APIC Guidelines for hemodialysis facilities clearly stated that patients should be educated as to that which the staff will do to prevent an infection and be involved so that there is a culture whereby patients/families are encouraged to remind staff. -- - it is a team.
Roberta Mikles
www.qualitysafepatientcare.com

[Brian Riddle]

I'm always amazed how much you hear about washing your hands in the hospital, but yet most of the medical equipment used is never sanitized. Some examples are bp cuffs, pulse oximeters, stethoscopes and the remote control and nurse buzzer are just a few examples. I rarely see these items wiped down. Especially stethescopes.
I believe if these items were cleaned after each use, then this would cut down on germs greatly. I have watched rooms be cleaned after a patient and these items are never touched.

[Peter Laird, MD]

Brian, actually one of the dirtiest items in a hospital setting is a doctors beeper and phone. Despite all that we know about the benefits of hand washing, not just for the patient, but the staff as well, it continues to be ignored on a regular basis.

You are correct about the BP cuffs and other items listed. I routinely refuse to allow anyone to use a stethoscope on my fistula. If you can't feel the throb with your fingers after washing the hands, what will the nurse learn by listening to the thrill that is already readily palpable. I just simply don't allow it at all.

In addition, I always use a chucks on my arm when they want to take my BP in clinic, ALWAYS. Looking out for your own safety and understanding what is the correct techniques is a survival strategy that all patients need to adopt since so many health care "professionals" fail to act in the professional manner we expect them to act.

[roberta mikles]

In dialysis units, that I have been in, I have observed signs related to hand washing, etc. but does it help? The surveys at www.qualitysafepatientcare.com will tell the story.

I was sent this today..
"""""""Zero is the Greatest Number," reads the logo, part of the prestigious hospital's campaign to drive down to zero the number of infections within its walls. The posters appear in all 42 elevators in the facility, reminding employees and assuring patients and visitors that Cedars has infections in its sights."""""""
Roberta Mikles
Dialysis Patient Safety Advocate
www.qualitysafepatientcare.com

[Peter Laird, MD]

Perhaps it will be a grass roots movement in the dialysis field that yields the greatest benefits. Perhaps the dialysis profession will be just that, a profession where the highest standards and ideals are the driving force. Perhaps home dialysis will once again be the operative choice for the majority of patients as it once once. Perhaps one day, we will put all of the elements together that Dr. Scribner sought all those years. Just perhaps.

[Denise Eilers]

Peter, I am printing this to take and share with my students today. More later.

[roberta mikles]

With the latest article released today
regarding California's poor passing rates for dialysis certification, (link below) -we must again look deeper into that which happens in facilities as evidenced in survey findings, especially that related to infection prevention. Do these numbers suggest that technicians are not being adequately trained/educated/supervised? This is certainly something to consider. A suggestion to providers would be to re-evaluate their training programs and include a more in depth educational component focused on rationale for policies and procedures and consequences (patient negative outcomes) for not implementing correct practices.
Deficiencies cited clearly indicate that something is wrong amidst this vast scene. www.qualitysafepatientcare.com

http://californiawatch.org/dailyreport/nearly-half-dialysis-technicians-failing-skills-test-8265?destination=node%2F8265%23comment-form%23comment-form

Roberta Mikles RN
Dialysis Patient Safety Advocate

[roberta mikles]

The question that I keep being asked is, "If staff are appropriately trained and educated in correct practices, however, do not implement such, is this an intentional act to place a patient in harm's way? Interesting question, indeed. One would think that with infection being the second cause of death that this area would be stressed, but, according to the surveys conducted in Calif as well as per CMS, the most cited (frequent) deficiency is infection control, the most basic of basics e.g. hand washing and glove changing. So, I ask, what is the problem that staff do not implement practices. As I have stated, in numerous units I have been in, I have observed staff, not in an emergency situation, but with enough time, to implement correct practices. I just don't get it
Roberta Mikles RN BA
www.qualitysafepatientcare.com

[Peter Laird, MD]

Roberta, that actually falls under negligent care in my opinion as a professional health care worker. The risks of improper hygiene are part of licensing with all that work in direct patient care. Yes, that is basic negligence.

[roberta mikles]

Peter, agree. Many ask further, if a patient experiences a negative outcome, be it infection, or other, and staff have not implemented correct practices, should these individuals be reported to the licensing or certification agencies? Perhaps, providers should incorporate into their training/education programs the consequences that can happen to staff when such happens. Most, in my opinion, are not cognizant of such. In fact, I remember a staff contacting me and asking me if she would lose her job because of an incident in her unit. Staff should be made aware, again, of the seriousness of such patient negative outcomes. I am not sure this is fully instilled in staff. And, I still do not understand why it is so difficult for staff to carry forth the most basic of basic infection control practices. I find it totally unacceptable. Providers, at the corporate level, work towards improving care, decreasing numbers of infection, but that which we see, from the survey findings, at the unit level, well, something is lacking. I still say that managment staff must be more on their toes in identifying these care deficient practices that the surveyors identify when they are in the unit. And, personally, it is my opinion, that this is shameful.. especially when there are Conditions NOT met in Infection Control and upon return for revisit surveys, the same problems are identified.
Roberta Mikles
www.qualitysafepatientcare.com

[wrong diagnosis claim]

like the video appreciated work. awesome one

[Astrid Herrera]

Posting comments is not the solution, lets organize a movement about this , as MEDICAL STAFF, HELP THE PATIENTS AND WASH YOUR HANDS...

[Roberta Mikles BA RN]

I see that someone posted to this recently, .. Here we are, a year and a half later and we continue to see (California) staff NOT implementing correct infection prevention practices.. HELLO PROVIDERS???? It is evident that staff continue to NOT be adequately trained/educated in order to adhere to facility policies/procedures as well as federal regulations, -- to support this opinion go to www.qualitysafepatientcare.com and read some inspection (survey) reports
opinions of Roberta Mikles