Standardization Staves Off Infections

From gloving to hand hygiene compliance, here’s how to ensure consistency among your OR team.

The road to poor infection prevention practices is often paved with good intentions from staff. That’s why Michelle Barron, MD, is such a strong proponent of regular and varied education on why essential protocols for practices such as hand hygiene and gloving are in place.

Dr. Barron, who serves as the senior medical director of infection prevention and control for UCHealth, a Colorado-based health system comprised of 12 hospitals and more than 150 clinics, uses gloving as a prime example. “Sometimes you’ll hear someone say something like, ‘I didn’t change gloves because I didn’t want to go through five pairs. I was trying to save the hospital money.’” Clearly that person thought they were doing the right thing, and yet they presented an important teachable moment for Dr. Barron to nip a problematic behavior in the bud the right way. “When I see someone who has good intentions but is just a bit off the mark, I tell them, ‘Look, I really appreciate your effort, but you’re probably causing more harm than you actually intended because...’”

What you can do

To ensure consistent compliance among your staff when it comes to infection prevention protocols, Dr. Barron encourages a multi-pronged approach that consists of the following best practices.

• Keep it simple. Infection prevention leaders should regularly look at the protocols they expect staff to follow and ask themselves: A. Is it a part of the natural workflow? B. Is it simple? Hand hygiene is an easy place to test the natural/simple component of things, according to Dr. Barron, who points out that there are studies spelling out the ideal number of sinks per square foot a facility should have in place to ensure hand hygiene compliance. “If you need to walk down the hall to go to do hand hygiene, the likelihood of you remembering to do it is low, not because you are trying to be bad, but because you’re so busy,” she says. To ensure staff has access to everything they need to comply, Dr. Barron will regularly step back and look at processes from staff’s point of view. “A lot of times we think something is in a great place, but we’re not the ones working there,” she says. “We need to find out, ‘Where would you want it?’”

When it comes to donning and doffing gloves, Dr. Barron also urges a simple, straightforward approach to the messaging. “Bottom line, you want to do it before you enter a room, and after you leave,” she says. “People will argue that they didn’t touch the patient, but the room or the space someone is in is basically considered contaminated, and this practice protects you and it protects the patient.” For instance, Dr. Barron points out that even if you didn’t touch the patient, maybe you touched a bacteria-covered IV pole and touched your nose or grabbed your phone. Here, a standardized donning/doffing protocol will protect you.

With any type of education, you need to ask yourself, ‘Who’s the learner and what is it that appeals to them?’
Michelle Barron, MD

• Err toward positive reinforcement. Like many infection prevention-focused facilities, UCHealth does blind, random audits of hand hygiene compliance — from someone outside of infection prevention.

“There’s somebody who’s embedded in the unit, so staff have no idea they’re being watched, and that person will provide feedback on what they saw,” says Dr. Barron, adding that the most successful form of feedback is positive reinforcement. For example, one of UCHealth’s units handed out Life Savers candy every time somebody did a good job and saw its productivity and ability to maintain high levels of compliance rose dramatically. “It seems simple in its concept — giving out a Life Saver — but it really went a long way where that positive reinforcement had people going, ‘Wow, that was cool. I got candy,’” says Dr. Barron. “The instinct is to tell people they are doing something wrong, but by emphasizing the positive you’re more likely to get people on board.”

• Appeal to the learner. Effective training and education are cornerstones of every solid infection prevention initiative, but getting the message to stick is often a very nuanced process. “With any type of education, you need to ask yourself, ‘Who’s the learner and what is it that appeals to them?’ and go from there,” says Dr. Barron. For instance, some staffers simply want to hear what they’re supposed to do from the infection prevention standpoint. “Some people are like, ‘If she said it, it’s good enough for me,’” she says. “Some people are like, ‘What’s the data behind all this?’” If staff fall into the latter category, Dr. Barron will sometimes go beyond the high-level education and send out relevant papers or even invite the person to grab a cup of coffee and talk details. Ultimately, flexibility in presenting info on the why behind your policies and protocols is what makes infection control education most effective — and the more flexibility the better.

Of course, specialty often plays a role in how the learners take in information and what approach is used to convey it. “I jokingly tell people that if I’m presenting to a group of surgeons, I’d better have everything on a single PowerPoint slide,” says Dr. Barron, adding that this group is used to reacting to and processing information very quickly and then doing what needs to be done. “That’s a good thing. We need surgeons to think and work quickly,” she says. “If someone’s operating on me, I don’t want them to sit and ponder their next move for 30 minutes. I need them to act quickly and decisively.” Infection prevention information presented to nurses, on the other hand, must be presented differently, Dr. Barron explains. “Nurses are often very data-driven, but they tend to want a little bit more meat,” she says. “I can’t just say, ‘You should do this because I said so,’ so I tend to give them a little bit more.”

Stopping the spread

When it comes to infection control staples such as standardized and seamless gloving and hand hygiene, one key quantifier will give you a lot of insight into how well your team is doing: spread. If staff is doing everything correctly, bad organisms will stay limited to patients and won’t spread. If there’s a spread, something failed somewhere along the way. Put another way: “If I did my job well, you won’t see me,” says Dr. Barron. “Not seeing me — that’s a good thing.” OSM

Note: This three-part article series is supported by Ansell.