Operational/Environmental Methods to Prevent CMS Readmission Fines Due to Healthcare-Associated Infections (HAI’s)-Part I-Hand Hygiene

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Randy Charpentier

By Randall B. Charpentier, HEM, President/Principal Consultant: HealthSafe New England

As indicated in my introduction  to this blog series, hospital readmission rates and fines from the Centers for Medicare & Medicaid Services (CMS) are staggering. This post addresses hand hygiene guidelines for operational staff. No doubt, constant vigilance with clinical staff (especially physicians) who have direct contact with patients need to be continually reinforced.There is a long standing challenge with healthcare organizations attempting to ensure compliance with their infection prevention policies with ancillary/non-clinical and contracted personnel.

In a recent article published by The Joint Commission Journal on Quality and Patient Safety, they conducted a study where it was noted that compliance is less than 50% at most hospitals. When they concluded their study and implemented necessary change, the results produced a higher compliance rate to 70% which is an encouraging improvement, but is it sufficient? Another area of focus should be on non -clinical/support staff and contractors/vendors. Ongoing training consistent with CDC guidelines and reinforcement of policy should be a frequent and standard practice in every facility. Source. When healthcare facilities focus on shifting their culture and committing to a “safety first” attitude with staff and patients, I’ve witnessed a profound change in reduction of incidents, improved communications, high morale, cost savings and higher than normal staff retention rates to name a few. It also tends to benefit other critical elements in an organizations safety management program that reduce injuries, illness and improved compliance with their infection prevention efforts.

Of the many instances where I can provide anecdotal evidence, I’ll share some profound observations:

  • The first was when I was tasked with overseeing construction and renovation of occupied OR’s, ICU’s and Med/Surge floors in adjacent spaces. The clinicians were concerned with the amount of noise and vibration with the project as they voiced their discomfort in project meetings. As a project team leader, we made every attempt to minimize any disruption to patient care including low census/highly disruptive activities. It seemed like nothing ever worked as we had to demolish existing walls and utilities to construct new. Dust and particulate release was never a complaint as we took great measures to ensure that the project was adequately sealed with negative pressure/hepa filtered to the exterior of the project envelope and the workers were wearing protective tyvex suits and heap vac’d prior to leaving as to not carry the work contaminants outside of the project including tacky mats as you’re all aware. We placed hand sanitizer dispensers at the entry of each worksite and constantly reminded the trades professionals to utilize when exiting the project envelope. Training and enforcement was the key in making sure that minimal to no contaminants exited the worksite.
  • Another instance occurred as I was leaving a job site to go to the rest room and was accompanied by a prominent physician. As we finished our duty, I proceeded to the sink of course. Did the physician? Nope, he went along his merry way. Not to target physicians in this post, just sharing an observation. Not to say that all physicians are complacent with proper hand hygiene, but the key in this point is who is reminding the doc’s to practice proper infection prevention practice and who is enforcing the policies?
  • I rarely see facilities/maintenance/construction personnel washing or sanitizing their hands as often as they should. I firmly believe that this is an area of challenge and opportunity as this could easily be classified as indirect or incidental contact in the spread of HAI’s. Facilities should constantly remind and enforce infection prevention policies with their staff and contracted personnel. Impossible to enforce, I know. Just another area of opportunity to combat HAI’s.

hand washing Hand Hygiene – Most healthcare facilities do an exemplary job of training staff on proper hand hygiene, especially clinical staff that are in direct contact with patients. However, one area of improvement could be enhanced observation and one on one counseling when a staff member is observed to be less than vigilant with their technique. It doesn’t have to be punitive/disciplinary unless it’s a repeated behavior that jeopardizes patient/staff safety. Enforce procedure and hold staff accountable. Another area of focus should be on non -clinical/support staff and contractors/vendors. Ongoing training and reinforcement of policy should be a frequent and standard practice in every facility. Source

Randall Charpentier is a 20 year experienced, safety and risk management consultant specializing in healthcare compliance and best practice management. Project experience ranges from leading teams on the construction of the west coast space shuttle project, working internationally & domestically for leading environmental engineering firms conducting real estate assessments involving occupational and environmental risks, assessing business operational risks concerning commercial insurance policies, and reducing/eliminating exposures/hazards, to leading world renowned, top ten/one hundred community based & BioMedical Research/Teaching hospitals, with development and execution of best practices with EOC, Fire/Life Safety, Infection Prevention in Healthcare Construction, and Emergency Management programs.  HSNE’s/Randall’s passion is keeping patients, staff and visitors safe in a healthcare setting.  CMS is measuring safety and quality in healthcare facilities basing reimbursement on healthcare outcomes. Does your facility measure up? If not, you should conduct a risk assessment. Is your facility compliance or results driven? To find out, contact rcharp@hsnellc.com or www.hsnellc.com, or LinkedIn profile.

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7 Responses to Operational/Environmental Methods to Prevent CMS Readmission Fines Due to Healthcare-Associated Infections (HAI’s)-Part I-Hand Hygiene

  1. Pingback: Preventing Costly CMS Fines for Readmissions due to HAIs Part V: The Impact of Technological Advances

  2. Pingback: Preventing CMS readmission fines due to Healthcare Acquired Infections (HAI’s)-Part IIIa-Ventilation

  3. Pingback: Preventing CMS readmission fines due to Healthcare Acquired Infections (HAI’s)-Part II-Personal Protective Equipment

  4. Beth_Boynton_RN_MS says:

    Thanks for your research, resources and profound observations, Randy. I have to say your observations are sadly not surprising.

    I think you raise an extremely important point about the ‘safety first’ culture or mindset. When that is our priority all sorts of wonderful things can happen! It is worth adding that the ability to give and receive constructive feedback is a communication skill integral to building and maintaining such a culture. When all levels of staff are practicing this give and take there is an ease about reminding each other to wash hands, (or follow any protocol) as well as an enthusiasm for inquiry, and commitment to learning and teaching.

    I also thought the TJC report was quite interesting:
    http://www.jointcommission.org… Targeted solutions make a lot of sense and seem like they would inherently engage staff in identifying problems and collaborate and comply with solutions. Made me think of the observer effect in quantum mechanics. Not that I understand that completely, but focusing more intently on the problem, some change seems likely and the increase from 50-70% compliance might have something to do with that? I don’t think 70% is enough btw although certainly appreciate the outcomes. I’ve thought for a long time that one of the keys to solving the handwashing dilemma is for leaders to ask staff what they need in order to comply. Then listen and dialogue about supporting processes. Staffing, sink locations and probably many of the things mentioned in the TJC article would surface and staff would be engaged.

  5. Guest says:

    Thanks for your research, resources and profound observations, Randy. I have to say your observations are profound, but sadly not surprising.

    I think you raise an extremely important point about the ‘safety first’ culture or mindset. When that is our priority all sorts of wonderful things can happen! It is worth adding that the ability to give and receive constructive feedback is a communication skill integral to building and maintaining such a culture. When all levels of staff are practicing this give and take there is an ease about reminding each other to wash hands, (or follow any protocol) as well as an enthusiasm for inquiry, and commitment to learning and teaching.

    I also thought the TJC report was quite interesting:
    http://www.jointcommission.org/assets/1/18/JQPS_1_15.pdf Targeted solutions make a lot of sense and seem like they would inherently engage staff in identifying problems and collaborate and comply with solutions. Made me think of the observer effect in quantum mechanics. Not that I understand that completely, but focusing more intently on the problem, some change seems likely and the increase from 50-70% compliance might have something to do with that? I don’t think 70% is enough btw although certainly appreciate the outcomes. I’ve thought for a long time that one of the keys to solving the handwashing dilemma is for leaders to ask staff what they need in order to comply. Then listen and dialogue about supporting processes. Staffing, sink locations and probably many of the things mentioned in the TJC article would surface and staff would be engaged.

    More good basic communication than rocket science!

  6. Guest says:

    Thanks for your research, resources and profound observations, Randy. I have to say, the observations you discus are sadly not surprising.

    I think you an raise extremely important point about the ‘safety first’ culture or mindset. When that is our priority all sorts of wonderful things can happen! I also think it is worth adding that the ability to give and receive constructive feedback is a communication skill integral to building and maintaining such a culture. When all levels of staff are practicing this give and take there is an ease about reminding each other to wash hands, (or follow any protocol) as well as an enthusiasm for inquiry, and commitment to learning and teaching.

    I also thought the TJC report was quite interesting:
    http://www.jointcommission.org/assets/1/18/JQPS_1_15.pdf

    Targeted solutions make a lot of sense and seem like they would inherently engage staff in identifying problems and collaborate and comply with solutions. Made me think of the observer effect in quantum mechanics. Not that I understand that completely, but focusing more intently on the problem, some change seems likely and the increase from 50-70% compliance might have something to do with that? I don’t think 70% is enough btw although certainly appreciate the outcomes. I’ve thought for a long time that one of the keys to solving the handwashing dilemma is for leaders to ask staff what they need in order to comply. Then listen and dialogue about supporting processes. Staffing, sink locations and probably many of the things mentioned in the TJC article would surface and staff would be engaged.

    More good basic communication than rocket science!

  7. Thanks for your research, resources and profound observations, Randy. I have to say, not of your experiences are surprising. I think you an raise extremely important point about the ‘safety first’ culture or mindset. When that is our priority all sorts of wonderful things can happen! I also think it is worth adding that the ability to give and receive constructive feedback is a communication skill integral to building and maintaining such a culture. When all levels of staff are practicing this give and take there is an ease about reminding each other to wash hands, (or follow any protocol) as well as an enthusiasm for inquiry, and commitment to learning and teaching.

    I also thought the TJC report was quite interesting:
    http://www.jointcommission.org/assets/1/18/JQPS_1_15.pdf Targeted solutions make a lot of sense and seem like they would inherently engage staff in identifying problems and collaborate and comply with solutions. Made me think of the observer effect in quantum mechanics. Not that I understand that completely, but focusing more intently on the problem, some change seems likely and the increase from 50-70% compliance might have something to do with that? I don’t think 70% is enough btw although certainly appreciate the outcomes. I’ve thought for a long time that one of the keys to solving the handwashing dilemma is for leaders to ask staff what they need in order to comply. Then listen and dialogue about supporting processes. Staffing, sink locations and probably many of the things mentioned in the TJC article would surface and staff would be engaged.

    More good basic communication than rocket science!

What are your thoughts?