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Best Practices

Hopkins Hands at Work

The following programs are just a handful of hand hygiene success stories from around Johns Hopkins Medicine.

Hand Hygiene Awards Programs

ICU Golden Hands Winners

The hand hygiene traveling trophy is awarded by Johns Hopkins Bayview’s Hand Hygiene Committee. The trophy is circulated monthly to the unit with the highest hand hygiene compliance rate.

The traveling trophy is just one of many unit- and individual-based initiatives the Department of Infection Control sponsors to promote positive hand hygiene behaviors.
Any unit who meets or exceeds the hospital-wide compliance goal of 85 percent each month will be entered into a quarterly raffle to win their choice of a pizza party or ice cream social. In addition, infection control and other staff will hand out stickers to individuals for practicing good hand hygiene. Stickers can be redeemed for a chance to be entered into a quarterly raffle for great prizes, such as a Kindle or one of many customized gift baskets.

Sibley Memorial Hospital has a similar awards program, which is called the Golden Hands Award. The ICU team was the first to win the award in January 2012 (pictured above).

Twin Patients Star in Scrub A Dub Dub Video

After surveying staff and parents of patients, a Hand Hygiene Task Force at All Children’s Hospital heard that additional education on proper hygiene techniques was needed. This led to the creation of Scrub A Dub Dub, a hip-hop music video starring two All Children’s patients, with appearances by physicians, nurses and employees.

The video concept, music and lyrics are the work of All Children’s Creative Services Department. Creative Services filmed and edited the video, which stars eight-year-old twins, one of whom spent months in the All Children’s Pediatric Intensive Care Unit in 2009, fighting a case of Guillain-Barre Syndrome that left him connected to a ventilator and almost completely paralyzed. His appearance in the video was a fitting celebration of his recovery. Physicians, nurses and other employees also appeared in the video, increasing hospital-wide interest in the project.

The video was introduced to employees at departmental staff meetings. It was shared with the community through a news story on the local Fox affiliate and shared with medical staff through meetings and a monthly electronic newsletter. Several electronic screen savers featuring shots from the video appear on computers throughout the organization, including the clinical computers that are at each patient’s bedside. The video was also featured in the electronic employee newsletter, on the hospital’s intranet site, on the hospital’s external website and on All Children’s YouTube channel.

To help educate patients, families and visitors, the video was uploaded to the GetWellNetwork education and entertainment system that is present in each individual patient room, and at each patient station in the Dialysis Unit and Infusion Unit. Moreover, a newly admitted patient must watch the Scrub A Dub Dub video once before the system allows him/her to move on to other viewing choices.

Another educational opportunity for patients and families was the creation of “Dirt Squirt Alert” handouts that reinforce the video’s message. Creative Services developed these in cooperation with the nursing staff, the Family Engagement subcommittee of the Task Force, and the hospital’s Family Advisory Council. The bedside nurse or charge nurse presents the family with the appropriate handout at the time of admission, providing another teaching opportunity to stress the family’s important role in hand hygiene—including the opportunity to feel comfortable asking hospital staff if they have cleaned their hands. Finally, to celebrate International Hand Hygiene Day, families were asked to nominate caregivers who displayed excellent hand hygiene behaviors for a drawing for prizes.

To date, the Scrub A Dub Dub video has received numerous awards, including an Emmy nomination and several industry awards, and hand hygiene compliance among inpatient staff rose to 97 percent from a baseline of 93 percent at the project’s outset.

A Hands-on Approach to Detecting Germs

Glitterbug

Food handlers at Hopkins Hospital’s Department of Food and Nutrition were recently reminded that they too must be vigilant about clean hands. At an employee appreciation luncheon, clinical nutrition coordinator Rachel Lee teamed up with the Department of Hospital Epidemiology and Infection Control to raise awareness. Using a device called the Glitterbug Hand Show, nurse epidemiologist Keira Wickliffe, above left, applied a fluorescent gel to volunteers’ hands. Staff then placed their hands beneath the machine’s black light, which revealed germs as contrasting spots. Afterward, they washed their hands with sanitizer or soap and water and placed them into the device again, aided by hand hygiene compliance coordinator Valerie Finney. Even then, some spots reappeared. “This just proves,” says clinical nutrition assistant Duane Scruggs, “that you can’t tell by looking if your hands are clean.”

Resetting Expectations

When Sibley Memorial Hospital adopted a program last July that assigns specially trained staff to secretly monitor whether or not clinicians use Purell or wash their hands when entering and exiting patient rooms, only slightly more than half of those observed met the strict rules. One year later, however, their compliance rate is 94 percent—among the highest within Johns Hopkins Medicine.

Milena Walker, director of infection control and prevention, says Sibley initially struggled to improve its score after implementing the Hopkins Hospital model. When she discovered that many staff members did not follow the new rules nor understand the reasoning behind them, her team personally visited each unit. Training included a poignant video that showed how one patient suffered harm because of poor hand hygiene practices. This video proved to be extremely successful on the units as staff members could visually see the direct impact of poor hand hygiene practice. Realizing the effectiveness of video, Infection Control and Prevention incorporated the video into orientation for all new employees.

While scores increased in most areas, hand hygiene compliance rates in the D.C. hospital’s inpatient units still remained below the Johns Hopkins Medicine goal of 85 percent, set this year by a board of trustees committee that oversees the Armstrong Institute for Patient Safety and Quality and includes hospital executives and other safety and quality leaders across the health system.

Staff cited the harshness of the gel product in dispensers as an explanation for low scores, Walker says. When a gentler product was tried, compliance exceeded the goal in just one month, prompting a hospital-wide switch to the preferred sanitizer product.

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