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Human Factors Engineering and Positive Deviance. to Stop Hospital Acquired Infections (HAI) Will Sawyer MD APIC SW Ohio May 13, 2008. Audience participation during this presentation.

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human factors engineering and positive deviance
Human Factors Engineering and Positive Deviance

to

Stop Hospital Acquired Infections (HAI)

Will Sawyer MD

APIC SW Ohio

May 13, 2008

audience participation during this presentation
Audience participation during this presentation

Identify 2-3 other HCWs in this room and note how many times they “touch” their mucus membranes during this presentation.

(Positive Deviance behavior).

Possible “colonizer” of MRSA.

objectives
Objectives

1.Convert you to the practice of “Hand Awareness” (Hand hygiene and Respiratory Etiquette and cross contamination).

2. You understand the necessity for establishing a “culture of safety” in the healthcare environment.

3. You accept that the drastic situation of HAI requires drastic measures to make the change to protect both the patient and HCW from infectious disease (patient safety shield).

4. To understand that is transmission of HAI that is most important to reducing HAIs.

5. To understand that the Champion Handwasher Hospital Campaign will help your hospital accomplish the first 4 objectives.

who is dr will traditional medical role
Who is “Dr.Will” traditional medical role

Solo practice Family Medicine, 1986 to present, Cincinnati, Ohio

Trihealth Hospital System Patient Safety Committee, 2004-present.

Bethesda North Hospital Med. Executive Committee, 2000-07.

Bridges to Excellence: Pay for Performance Program, founding member, 2003-2005(NCQA, CMMS, GE, Humana et al).

Clean Hands Coalition, founding member and partner of CDC,

2003 to present.

Henry the Hand Foundation, founder 1999.

Henry the Hand Champion Handwasher, creator,1996.

Influenza Sentinel Network for CDC,member, 2003 to present.

Ohio Carrier Advisory Committee for Medicare Co-chair,

1994 to present.

Ohio Medicaid Advisory Committee member 1995-2004.

Patient’s Choice, founder and President/CEO, 1993-2003, 450 physician IPA

AMA OMSS, delegate, 1999 to 2007.

who is dr will positive deviance strategist
Who is “Dr.Will” Positive Deviance Strategist

Solo practice Family Medicine, 1986 to present, Cincinnati, Ohio

Bridges to Excellence: Pay for Performance Program, founding member, 2003-2005(NCQA, CMMS, GE, Humana et al).

Clean Hands Coalition, founding member (partnership of CDC, USDA, ASM, SDA, industry and universities) 2003 to present.

Influenza Sentinel Network for CDC, one of 100 sites,member, 2003 to present.

Hand Awareness presentations:

Non Pharmaceutical Approach to Prevent Human Illness and Transmission of Emerging Pathogens;

NEHA 2006,

NAHEC 2006 and

USDA Food Safety Conference, 2006.

Human Factors Engineering:

Stopping Hospital Acquired Infections, TapRoot(Root Cause Analysis) Conference 2007

Champion Handwasher Hospital Campaign presentations:

John Muir Health System 2006

Thompson Health System 2006

slide6

A Hospital System can drastically reduce HAI by looking in the mirror.

Of the 98,000 preventable deaths each year 90,000 are due to infectious disease, according to IOM.

this tool kit will help meet the elements of performance for jcaho ic 4 10
This Tool Kit will help meet the Elements of Performance for JCAHO IC.4.10

1. Interventions are designed to incorporate relevant guidelines for infection prevention and control activities.

Interventions are implemented which include the following (EPs 2 and 3):

2. A hospital wide hand hygiene program that complies with current CDC hand hygiene guidelines (National Patient Safety Goal 7, requirement 7a.)

3. Methods to reduce the risks associated with procedures, medical equipment, and medical devices, including the following: Appropriate storage, cleaning, disinfection, sterilization, and/or disposal of supplies and equipment.

the tool kit meets the national patient safety goal 7
The Tool Kit meets the National Patient Safety Goal 7
  • Reduce the risk of health care-associated infections.

Requirement 7A: Comply with current CDC hand hygiene guidelines. note: This requirement is scored at standard at IC.4.10,EP 2.

Requirement 7B: Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.

the power of positive deviance
The Powerof Positive Deviance

Solutions before our very eyes

The Premise:

In every community there are certain individuals whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources

let s admit to the public that hcws need to make changes to prevent the spread of hai
Let’s admit to the Public that HCWs need to make changes to prevent the spread of HAI.

As HCWs, we are interested in a “culture of safety” in the hospital to achieve a “zero denominator” for HAI.

slide11
Evidence-based medicine and infection prevention measures can go no where without our ability to influence decision-makers to support our efforts and to persuade healthcare teams to adopt safe behaviors.

Denise Murphy RN, BSN, MPH, CIC,

VP, Chief Patient Safety and Quality Officer

Barnes-Jewish Hospital

Washington University Medical Center

culture of safety
Culture of Safety

It is only through “genuine communication” and accountability for ones behavior in the hospital community, that we will foster a “culture of safety”, that will help prevent the spread of infectious disease, hence HAI.

A key component to the Champion Handwasher Hospital Campaign success is based upon one’s personal awareness and personal accountability not age, educational accomplishments or level of authority in the hospital community.

human factors engineering
Human Factors Engineering
  • We need to apply the same evidence based medicine approach to empower HCWs that the Power of Infection Prevention is in their hands! They simply need more Hand Awareness practice.
hand awareness
Hand Awareness
  • Knowing where your hands are and what they are doing AT ALL TIMES.
  • Scientifically stated it is the integration of Hand Hygiene, Respiratory Etiquette and cross-contamination awarenessin a best practice model.
how new is hand awareness
How New is Hand Awareness?
  • John Snow MD(1854): Broad Street pump handle and Cholera epidemic.
  • Ignaz Semmelweis MD (1847): Perinatal mortality reduced by using a dilute chlorine solution rinse between the morgue and L&D suite.
  • Although it took 20 years for acceptance of both their discoveries now described as Positive Deviance.
  • Will Sawyer MD(1999): The 4 Principles of Hand Awareness as primary infection prevention.
  • Let’s not wait 20 years to accept and miss the opportunity to prevent many HAIs.
preventing transmission is an important part of mrsa control
Preventing transmission is an important part of MRSA control
  • Entire healthcare-associated MRSA problem caused by spread of a few clones
  • Preventing widespread colonization minimizes circulating pool of resistance genes that can contribute to cycle of increasing multi-drug resistance (e.g. VRSA is likely a product of widespread colonization with VRE and MRSA)
  • Improving antibiograms helps ease pressure for broad spectrum antibiotic use and preserves effectiveness of preferred antimicrobial agents
  • Preventing colonization helps prevent infections
    • Including those that might happen post-discharge (newly colonized patients have up to 30% risk of infection in the ensuing year).

*Prevention and Control of Healthcare-associated MRSA, John Jernigan MD, Division of Healthcare Quality Promotion, CDC and Prevention April 29, 2008.

so what do we need to change today to prevent hai
So what do we need to change today to prevent HAI?

STOP TRANSMITTING by OUR HANDS!!!

1. Practice the 4 Principles of Hand Awareness.

2. Stop keyboard and RFID gun cross contamination

during patient care.

3. Remove neck ties that are causing cross

contamination.

4. Stop using cell phones in the midst of patient care

that are contributing to cross contamination.

5. There will be more suggestions to better engineer

the patient care process.

pd focus on practice rather than knowledge
PD Focus onPracticeRatherthan Knowledge

“It’s easier to ACT your way into a new way of THINKING, than to

THINK your way into a new way of ACTING”

the 4 principles of hand awareness
The 4 Principles of Hand Awareness

1. Wash your hands when they are dirty and before eating.

2. Do not cough into your hands.

3. Do not sneeze into your hands.

4. Above all, do not put your fingers into your eyes, nose or mouth.

*Endorsed by the AMA and the AAFP (2001)

*referred to as individual ideas for flu prevention by CDC, but not packaged as an integrated concept.

the 4 principles of hand awareness1
The 4 Principles of Hand Awareness

1. Wash your hands when they are dirty and before eating.

2. Do not cough into your hands.

3. Do not sneeze into your hands.

4. Above all, do not put your fingers into your eyes, nose or mouth.

*Endorsed by the AMA and the AAFP (2001)

*referred to as individual ideas for flu prevention by CDC, but not packaged as an integrated concept.

the 4 principles of hand awareness2
The 4 Principles of Hand Awareness

1. Wash your hands when they are dirty and before eating.

2. Do not cough into your hands.

3. Do not sneeze into your hands.

4. Above all, do not put your fingers into your eyes, nose or mouth.

*Endorsed by the AMA and the AAFP (2001)

*referred to as individual ideas for flu prevention by CDC, but not packaged as an integrated concept.

the 4 principles of hand awareness3
The 4 Principles of Hand Awareness

1. Wash your hands when they are dirty and before eating.

2. Do not cough into your hands.

3. Do not sneeze into your hands.

4. Above all, do not put your fingers into your eyes, nose or mouth.

*Endorsed by the AMA and the AAFP (2001)

*referred to as individual ideas for flu prevention by CDC, but not packaged as an integrated concept.

slide23
We ALL know or have heard of someone who went into the hospital contracted MRSA,VRE, C. difficile or other infectious diseases causing illness or death!

Which health systems are consistantly 75% compliant with CDC Hand Hygiene guidelines?

Correct, none!

slide24

The emergence of MRSA has been due to transmission of relatively few clones,

not de novo selection

Hiramatsu, et al. Trends in Microbiology 2001;9:486

hcws are a petri dish for many diseases in the hospital
HCWs are a Petri Dish for many diseases in the hospital.

Remember as long as we do not introduce the infectious disease into our mucus membranes then the disease will less likely spread in and out of the hospital.

which behaviors are we talking about
Which Behaviorsare we talking about?
  • Nose picking and rubbing
  • Eye rubbing
  • Nail biting, finger licking, etc.

Curtailing these habits,

“Is a simple solution

to a complex problem”

of HAI.

pd enables us to act today
PD Enables us to Act TODAY

Although most problems have complex, interlinked underlying causes . . .

The presence of Positive Deviants demonstrates that it is possible to find successful solutions TODAY before all the underlying causes are addressed!

perhaps we should institute wearing a patient safety shield as a safety device
Perhaps we should institute wearing a Patient Safety Shield, as a safety device?

Creating a “physical barrier” to prevent inoculation and colonization of MRSA and other germs to reduce Hospital Acquired Infections (HAI).

slide29
“It is our duty to our Patients, their families and healthcare workers…

Let us move forward together!

Each of us can make a difference; a small but significant effort from all of us.”

Sir Liam Donaldson – Professor Didier Pittet MD

Clean Hands reduce the burden of disease.

Lancet;366:185-86, 2005

slide30
There are several models talking about the Culture of Safety hospital wide:

“Cleanyourhands”Campaign in the U.K.

“Clean Care is Safer Care” by the WHO

“Champion Handwasher Hospital

Campaign” in the U.S.

slide31
Hospitals are still functioning in “silos” in OUR communities.
  • Collaborating to teach a consistent message can help protect the public, our patients, from HAI.
  • Introducing “friendly competition” between hospitals in a region will help initiate the “culture of safety” in your region.
most healthcare associated invasive mrsa infections have their onset outside of the hospital

Community-Associated

Healthcare-Associated (community-onset)

Healthcare-Associated (hospital-onset)

Most Healthcare-Associated Invasive MRSA Infections Have Their Onset Outside of the Hospital

28%

14%

59%

Source: ABCs Population-based surveillance System, Klevens et al. JAMA 2007

slide33
In December, 2006

IHI(Institute for Healthcare Improvement) initiated the 5 million Lives Campaign which asks hospitals to develop simple techniques to prevent MRSA infections in the hospital. And asks their Boards to “Get on board!”

The 4 Principles of Hand Awareness.

slide34
SHEA (Society for Healthcare Epidemiology of America) just finished their Annual Congress where they devoted much of their program to discussing programs to prevent MRSA infections.

The 4 Principles of Hand Awareness.

amazing preventable statistics in the us from the cdc and prevention
Amazing “preventable” statistics in the US from the CDC and Prevention!
  • 90,000 patients die each year from Hospital Acquired Infections (HAI)
  • 2,000,000 HAI occur each year, at a cost of $6.7 billion
  • 5,000 people die from food borne illness annually,
  • 76,000,000 cases of food borne illness annually
  • More than 300,000 hospitalizations due to food borne illness
  • 33,000,000 hospital admissions annually
more preventable statistics in the us from the cdc and prevention
More “preventable” statistics in the US from the CDC and Prevention!
  • 52,000,000 Upper Respiratory Infections occur each year,
  • 164,000,000 days lost from school due to illness,
  • 22,000,000 days lost from school due to the common cold
  • 36,000 people die from the Flu and flu-like illness annually
  • 800,000,000 patient visits annually
hcws nares organism found in several patients mediastinal site infections on the same floor 1989
HCWs Nares organism found in several patients mediastinal site infections on the same floor, 1989.

Reduction of Surgical site Infections in Cardiothoracic Surgery by Elimination of Nasal Carriage of Staphylococcus Aureus, Jan, AJ et al, Infection Control and Hospital Epidemiology, November 1996.

other evidence that the colonized hcws are the source for staph aureus outbreaks
Other Evidence that the “colonized” HCWs are the source for Staph aureus outbreaks
  • Boyce JM, Opal SM, Potter-Bynoe G, Medeiros AA. Spread of MRSA in a hospital after exposure to a HCW with chronic sinusitis. Clin Infect Dis 1993;17:496-504.
  • Boyce JM. Preventing Staphylococcal Infections by Eradicating Nasal Carriage of Staphylococcus aureus: Proceeding with Caution. Infect Control and Hosp Epidemiol 1996;17:775-779.
  • CoovadiaYM, Bhana RH. Johnson AP, Haffejee I, Marples RR. A laboratory confirmed outbreak of rifampin-methicillin resistant Staphylococcus aureus (RMSA) in a newborn nursery.. J Hosp Infect 1989;14:303-312.
  • Gaynes R, Maroska R, Mowry-Hanley et al. Mediastinitis following coronary artery bypass surgery: a 3 year review. J Infect Dis 1991;163:117-121.
  • Meier PA, Carter CD, Wallace SE, Pfaller MA, Herwalt LA. Eradication of MRSA from the burn unit at a tertiary medical center. Infect Control Hospital Epidemiol 1996;17:798-802.
perhaps we should institute wearing a patient safety shield as a safety device1
Perhaps we should institute wearing a Patient Safety Shield, as a safety device.

Since there is insufficient compliance with the CDC hand hygiene guidelines, creating a physical barrier to prevent inoculation and colonization of MRSA and other germs in nares would reduce HAI. (Positive Deviance strategy)

Prevention and Control of Healthcare-associated MRSA, John Jernigan, MD April 29,2008

hand awareness1
Hand Awareness
  • People who are “Hand Aware” are much less likely to contaminate themselves, another person, patient, device or surface.
  • Why would anyone knowingly give themselves E.Coli 0157:H7, MRSA,VRE, Shigella, Pertussis, Croup, Meningitis,TB, Flu, Strep, Impetigo, Pink Eye, hepatitis A and many others?
respiratory etiquette
Respiratory Etiquette
  • Principle 2 and 3.
  • Do not Cough or sneeze into your hand. Use a sleeve, kleenex, crook of your elbow, etc., anything except a bare hand. Very few people are running to the sink to wash their hands after coughing or sneezing.
  • Pertussis, viral illness, pneumococcus, meningococcus, SARS, Mumps, Measles, Rubella, and many similar diseases would be prevented by diligent practicing of the 4 Principles of Hand Awareness.
hand hygiene
Hand Hygiene
  • Principle 1 and 4.
  • Handwashing is publicly discussed.
  • Mucus membrane contact has NOT been “publicly discussed” as it should be, to prevent inoculation and colonization.
the hand is quicker than the eye
The Hand is quicker than the eye!

Unfortunately the single act of handwashing or sanitizing alone does not prevent

cross-contamination!

slide48
Bacterial counts on surfaces*:

2.7 million bacterial cells/ square inch on a drinking fountain.

33,800 bacteria/sq. inch on a cafeteria tray.

3,200 bacteria cells/sq. inch on a toilet seat.

260 bacterial cells/sq inch on key boards.

740 bacterial cells/sq inch on ear phones.

*National Sanitation Foundation, www.nsf.org

the hand is quicker than the eye1
The Hand is quicker than the eye!

People “unknowingly” touch a contaminated surface, then transmit the organism to another surface, themselves or a patient due to “unconscious” personal habits.

how soon after starting to work in the hospital do hcw nares become colonized with mrsa
How soon after starting to work in the hospital do HCW nares become “colonized” with MRSA?
  • 2 weeks? 6 weeks? Who is checking?
  • Does your pre-employment interview ask if you comply with the 4 Principles of Hand Awareness?
  • Or are you a nose picker, nail biter, finger licker, eye rubber, etc.?
  • 20-30% of HCWs are colonized with MRSA at any one time - Boyce,1996
slide51
When did the CDC and Prevention first address the issues of mucus membrane colonization, self inoculation and cross contamination?

1983

slide52

Guideline for Infection Control in Hospital PersonnelWalter Williams MD.MPH, Hospital Infections Program, National Center for Infectious Diseases, CDC and Prevention; July 17,1983:1-43

  • Staph aureus: If certain personnel are linked epidemiologically to an increased number of infections, these personnel can be cultured and, if positive, removed from patient contact until carriage is eradicated.
is any hospital following this guideline
Is any hospital following this guideline?
  • None that we know!
  • Concern, there may not be enough staff to care for the patients, is the usual response.
  • So why don’t we do a better job of preventing ourselves from being colonized and potentially infectious?
  • It’s just a habit! Not a good enough reason.
most invasive mrsa infections are healthcare associated

Healthcare-Associated

Community-Associated

Most Invasive MRSA Infections Are Healthcare-Associated
  • In the US in 2005 there were:
    • 94,360 invasive MRSA infections
    • 18,650 associated deaths

N = 8,987

14%

86%

Source: ABCs Population-based surveillance System, Klevens et al. JAMA 2007

how best to prevent mrsa transmission in healthcare settings
How best to prevent MRSA Transmission in Healthcare Settings?
  • Controversial subject
    • standard precautions versus standard plus barrier (i.e. contact precautions)?
    • Should contact precautions be used only on those identified by clinical cultures?
      • Due to “iceberg effect”, many colonized patients unrecognized base on clinical cultures alone
      • Should active surveillance be used to identify carriers?
  • If so, in what settings?
  • *Prevention and Control of Healthcare-associated MRSA, John Jernigan MD Division Health Care Promotion, CDC and Prevention April 29, 2008.
slide56

Guideline for Infection Control in Hospital PersonnelWalter Williams MD.MPH, Hospital Infections Program, National Center for Infectious Diseases, CDC and Prevention; July 17,1983:1-43

  • Viral respiratory infections: Masks probably will not completely protect personnel from patients with respiratory illnesses because large particles and aerosols may still reach the eyes, and self-inoculation from contaminated hands can still occur by touching the eyes.
legislation necessary
Legislation necessary?
  • Seat belts have been estimated to save 15,000 lives per year and prevent 132,000 injuries per year.
  • Adhering to the 4 Principles of Hand Awareness could significantly reduce the 90,000 estimated preventable HAI deaths per year.
mrsa is not walking out of the hospital
MRSA is not walking out of the hospital.
  • Staff, patients, visitors, vendors and others are carrying disease out on their hands, in the nares, clothing, equipment, etc.
  • How many of us “decontaminate” entering or leaving the hospital?
  • Why not?
decontaminating upon entering the hospital facility
“Decontaminating” upon entering the hospital facility,

if you do not want to carry

any disease into the facility

decontaminating upon leaving the hospital facility
“Decontaminating” upon leaving the hospital facility,

if you do not want to carry any disease out of the facility.

decontaminating upon entering home or work
“Decontaminating” upon entering home or work,

to minimize the chance of bringing in disease.

so how do you change hcws habits
So How do you change HCWs habits?

CDC, SHEA and many notable scientists put together a review in the MMWR in 2002.

First, you draw the HCWs attention to “what is your (their) habit?”

You will need to invoke a Positive

Deviance technique!

so how do you change peoples habits
So How do you change Peoples habits?

You help them change it by a few simple techniques (Positive Deviance) which help them stop the health risk behavior: i.e. touching their eyes, nose or mouth (mucus membranes). Wear a Patient Safety Shield. The barrier method is a great for prevention!

perhaps we should institute a patient safety shield as a teaching tool
Perhaps we should institute a Patient Safety Shield, as a teaching tool.

Creating a physical barrier will help teach us to prevent inoculation and colonization of MRSA and other germs, which will reduce HAI.

guideline for hand hygiene in health care settings j m boyce and d pittet mmwr 2002 51 rr16 1 44
Guideline for Hand Hygiene in Health-Care SettingsJ.M. Boyce and D. Pittet MMWR, 2002,51(RR16);1-44

Factors necessary for change include:

1. dissatisfaction with current situation

2. perception of alternatives, and

3. recognition, both at the individual and institutional level, of the ability and potential to change.

The first two necessitate a system change and the latter requires education.

guideline for hand hygiene in health care settings j m boyce and d pittet mmwr 2002 51 rr16 1 441
Guideline for Hand Hygiene in Health-Care SettingsJ.M Boyce and D. PittetMMWR, 2002,51(RR16);1-44

Factors necessary for change include:

1. dissatisfaction with current situation

2. perception of alternatives, and

3. recognition, both at the individual and institutional level, of the ability and potential to change.

The first two necessitate a system change and the latter requires education.

guideline for hand hygiene in health care settings j m boyce and d pittet mmwr 2002 51 rr16 1 442
Guideline for Hand Hygiene in Health-Care SettingsJ.M Boyce and D. Pittet MMWR, 2002,51(RR16);1-44

Factors necessary for change include:

1. dissatisfaction with current situation

2. perception of alternatives, and

3. recognition, both at the individual and institutional level, of the ability and potential to change.

The first two necessitate a system change and the latter requires education.

most importantly an improvement in infection control practices requires
Most importantly, an improvement in Infection Control practices requires:
  • Questioning basic beliefs
  • Continuous assessment of the group (or individual) stage of behavioral change
  • Interventions with an appropriate process of change
  • Supporting individual and group creativity

Because of the process of change, single interventions often fail. Thus, a multimodal, multidisciplinary strategy is likely necessary.

key prevention strategies

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

Key Prevention Strategies
  • Prevent infection
  • Diagnose and treat infection effectively
  • Use antimicrobials wisely
  • Prevent transmission

Clinicians hold the solution!

let s get started
Let’s Get Started

Let’s admit to ourselves that humans are responsible for transmitting disease and contaminating surfaces in the community setting.

Lets agree that we each have personal habits that may be contributing to the spread of infectious disease.

Let’s agree to not take offense when someone comments to us about our Hand Awareness technique.

Let’s agree that we are ALL sensitive about our personal habits and we agree to accept more public accountability that we want to protect our family and friends.

Lets agree that this process makes each and everyone of us a little nervous.

slide72

Predicted Number of EMRSA-15 Outbreaks

During 1993-98, United Kingdom

900

800

700

600

EMRSA-15 outbreaks 1993-1998

500

400

30% Duration

300

30% transmission

200

100

30%both

20%

40%

60%

80%

100%

Source: Austin JID

1999;179:883

% of Facilities Implementing Intervention

identify the champion handwasher officer
Identify the Champion Handwasher Officer

30%both

The purpose is to have one individual (Coach) who is responsible for coordinating the efforts of the healthcare team ensuring that this Campaign succeeds to benefit the patients in your hospital.

They are the contact point to the media.

Also to promote periodic “reinforcement activities” in the hospital to maintain a high level of compliance for the team, to ensure the hospital’s success.

champion handwasher hospital campaign
Champion Handwasher Hospital Campaign

We need to promote “genuine” communication across levels of authority to be successful.

  • It requires team work and true collaboration to improve the outcome.
  • It is human behavior “habits” and administrative barriers that need to be overcome to achieve a “culture of safety”.
champion handwasher hospital campaign1
Champion Handwasher Hospital Campaign

We need to promote “genuine” communication across levels of authority to be successful.

  • It requires team work and true collaboration to improve the outcome.

It is human behavior “habits” and administrative barriers that need to be overcome to achieve a “culture of safety”.

champion handwasher hospital campaign to prevent hai
Champion Handwasher Hospital Campaign to Prevent HAI.

We need to promote “genuine” communication across levels of authority to be successful.

Every successful team requires a Coach. Physicians are more like professional athletes than employees

  • It requires team work and true collaboration to improve the outcome.
  • It is human behavior “habits” and administrative barriers that need to be overcome to achieve a “culture of safety”.
slide77
OK

This Positive Deviant Strategy sounds plausible.

How do we get started?

slide78

To begin select a few phrases (slogans) to be used that tells a fellow HCW they did not wash or sanitize correctly, or breached one of the 4 Principles of Hand Awareness. (Positive Deviance)

Statement(s) that will not be offensive, and instead, reward our peers and other observers for their correct observation.

sample phrases
Sample Phrases
  • Are you a Germinator?
  • Don’t touch the “T zone”?
  • I do not think you washed before touching that patient.
  • Hey Bozo watch those digits!
  • You just broke one of the 4 Principles.
goals
Goals
  • Each HCW understands, practices and promotes the 4 Principles of Hand Awareness to their patients, colleagues, friends and family.
  • Each HCW will have a couple of simple non-threatening phrases to use when they notice another HCW breaches one of the 4 Principles of Hand Awareness.
slide81
Prepare you to launch the Champion Handwasher Hospital Campaign which will jump start the “culture of safety” initiative in the hospitals in your region?

Complying with CDC Hand Hygiene guidelines alone will not allow us to reach zero denominator for HAI.

We need to communicate and stop cross -

contaminating!

opportunities for mrsa prevention research
Opportunities for MRSA Prevention Research
  • Impact of focusing on high risk units
  • Use of topical antimicrobials/antiseptics for eradicating or suppressing S. aureus colonization
    • Chlorhexidine bathing of patients (targeted to colonized patients versus high-risk groups)
    • Use of topical antibioitics for decolonization (e.g. mupirocin)
  • Risk factors for healthcare-associated, community-onset (HACO) MRSA
  • Impact of hospital-based prevention programs on HACO
  • Use of mathematical modeling to understanding inter-facility transmission dynamics and implications for prevention
  • Novel techniques for changing organization culture as a means to improve adherence

*Prevention and Control of Healthcare-associated MRSA, John Jernigan MD, Division of Healthcare Quality Promotion, CDC and Prevention April 29, 2008.

conclusions
Conclusions
  • The burden of MRSAremains high in US healthcare settings
  • Community-associated MRSA (CA-MRSA) infections are emerging rapidly in many areas, but population-based estimates suggest that most MRSA infections are healthcare-associated
  • Epidemic strains of MRSA originally associated with the community have emerged as important causes of hospital-acquired infections
  • MRSA infections and transmission can be prevented, even in endemic settings in the US
  • Effective control programs must be multifaceted, and broad institutional commitment, including measurement of impact, is required for successful implementation

*Prevention and Control of Healthcare-associated MRSA, John Jernigan MD, Division of Healthcare Quality Promotion, CDC and Prevention April 29, 2008.

champion handwasher hospital tool kit
Champion HandwasherHospitalTool Kit

Reinforcement Tools for the Campaign, enlisting multimedia strategies (social marketing), that help break through traditional human defenses: Positive Deviance

Animation

Music

Visual prompts

Participatory demonstrations

slide92
Henry the Hand Champion Handwasher is prepared to be the National Coach,

make the Campaign “fun” and to improve our success to benefit OUR patients!

prevention and control of healthcare associated methicillin resistant staphylococcus aureus

Prevention and Control of Healthcare-Associated Methicillin-Resistant Staphylococcus aureus

John A. Jernigan

Division of Healthcare Quality Promotion

Centers for Disease Control and Prevention

April 29, 2008

The findings and conclusions in this presentation/report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

slide94
Positive Deviance Approach

For Behavior & Social Change

Funded through the Ford Foundation

Tufts University

traditional vs positive deviance problem solving approach
POSITIVE DEVIANCE

Internally Fueled

(by “people like us”,

same culture and resources)

Down-up, Inside-out

Asset Based “What’s right here?”

Begins with analysis of

demonstrably successful

SOLUTIONS

Solution Space enlarged through

discovery of actual parameters

Bypasses Immune System

(solution shares same “DNA” as host)

TRADITIONAL

Externally Fueled (by “experts”

or internal authority)

Top-down, Outside-in

Deficit Based “What’s wrong here?”

Begins with analysis of

underlying causes of PROBLEM

Solution Space limited by

perceivedproblem parameters

Triggers Immune System

“defense response”

TRADITIONAL VS POSITIVE DEVIANCE PROBLEM SOLVING APPROACH
slide96

A Few CA-MRSA Strains Cause

Most Community Outbreaks

100%

80%

60%

Pneumonia (AL, AR, IL, MD, TX, WA)

Pneumonia (AL, AR, IL, MD, TX, WA)

Pneumonia (AL, AR, IL, MD, TX, WA)

Pneumonia (AL, AR, IL, MD, TX, WA)

Pneumonia (AL, AR, IL, MD, TX, WA)

Pneumonia (AL, AR, IL, MD, TX, WA)

Missouri

Missouri

Missouri

Missouri

Missouri

Missouri

California

California

California

California

California

California

Athletes

Athletes

Pennsylvania

Pennsylvania

Pennsylvania

Pennsylvania

Pennsylvania

Pennsylvania

Colorado

Colorado

Colorado

Colorado

Colorado

Colorado

Mississippi

Mississippi

Mississippi

Mississippi

Mississippi

Mississippi

Texas

Texas

Texas

Texas

Texas

Texas

Prisoners

Prisoners

Georgia

Georgia

Georgia

Georgia

Georgia

Georgia

Tennessee

Tennessee

Tennessee

Tennessee

Tennessee

Tennessee

Texas

Texas

Texas

Texas

Texas

Texas

Children

Children

Missouri

Missouri

Missouri

Missouri

Missouri

Missouri

California

California

California

California

California

California

USA300-114

Community

Community

Community

Community

Community

Community

USA100

USA100

USA100

USA100

USA100

USA100

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

Hospital Strain

USA200

USA200

USA200

USA200

USA200

USA200