Connie Hauskins, RN, CMS, Nurse Manager, Children's Services
Katie Feldman, MS, ARNP, Breast Health Specialist, Women's Center
Jerri Salter, LMT, Massage Therapist, Women's Center
Cheryl Kissling, RN, IBCLC, Staff Nurse, Birthplace
Rachel Francois, ARNP, Nurse Practitioner, School-Based Clinics
Barb Worley, Administrative Secretary, Women's and Children's Services

***Watch a video clip of Mercy Medical Center's improvement work shared at IHI’s 19th Annual National Forum.***

To increase hand hygiene compliance hospital-wide to greater than 95 percent.

• Direct observation audits
• Healthcare-associated infection rates at Mercy Medical Center

• Cited by Joint Commission on the Accreditation of Healthcare Organizations for inconsistent hand hygiene practice
• Performed observational audits hospital-wide for three months which showed <75 percent compliance
• Challenged by CEO to do PDSA (Plan-Do-Study-Act) on hand hygiene on each unit
• Enlisted Women's and Children's team to develop campaign
• Developed picture poster: "What have you touched before you touched me?"
• Developed "Don't Bug Me" buttons
• Developed "Foam in, Foam out, EVERYONE" signs for patient room doors
• Displayed posters and signs on three pilot units
• Asked nursing staff to wear buttons on three pilot units
• Observed staff, physicians, and visitors for hand hygiene compliance
• Solicited staff input regarding reactions of poster, signs, and buttons
• Redesigned poster to cover up statistics of 90,000 deaths per year
• Redesigned button to add clip art bug and "Foam in, Foam out, EVERYONE"
• Retested on three pilot units
• Submitted campaign proposal to Administration

During the pilot study, compliance rates for hand hygiene improved. However, we're unable to assess the long-term impact on the healthcare-associated infection rate at this point in time. We recommend full implementation of the campaign to promote ongoing hand hygiene compliance.

• An administration that is committed to patient safety is imperative.
  • They initiated the house-wide hygiene campaign contest, providing the PDSA tool with starter information.
  • Our team's campaign was selected out of 86 proposals and will be developed by Marketing.
• Identified many more opportunities for hand hygiene per Centers for Disease Control and Prevention (CDC) guidelines than previously practiced.
  • Education is key to 95 percent compliance.
  • Using an eye-catching, thought-provoking slogan and poster to draw attention and heighten awareness is a must.
• Targeted everyone (patients, staff, and visitors) by developing a universal message since it requires EVERYONE's effort to limit infections.
  • Challenge from nurses who viewed the CDC facts as too "scary" for the general public and wanted the poster for staff education only.
• Discovered that it takes time and active team members to develop a plan, trial it, revise it and write it up. Ample time is important.
  • Initially given two weeks to accomplish this task; time frame was expanded to four weeks.
  • With tight schedules, it was still difficult to complete the project using the PDSA format.

Connie Hauskins, Nurse Manager, Children's Services
Mercy Medical Center
chauskins@mercycare.org

[Posterboard presentation at IHI's December 2007 National Forum]