September 18, 2007 in City

To curb infections from the spread of bacteria, Washington hospitals advise a direct approach

By The Spokesman-Review
 
Jed Conklin photo

Kyle and Issa Bascom, both 22, tend to their daughter Jada in their room in the Pediatric Hematology and Oncology Department at Sacred Heart Children’s Hospital in Spokane on Monday. Jada has leukemia, and all visitors and hospital staff are required to wash their hands before entering the room.
(Full-size photo)

Handy guide to hand hygiene

Nearly 2 million patients develop infections in U.S. hospitals each year, and about 99,000 people die, according to the federal Centers for Disease Control and Infection.

Patients and their friends and families should be assertive about asking everyone who enters hospital rooms to wash up before coming close.

Why should I say something?

Germs that cause infections can be spread in several ways, but the most common is through hand contact.

“What to say:

“Did you wash or sanitize your hands?”

“When to say it:

Ask anytime your doctor, nurse or health care worker is about to touch you or the things that are used in your care. Ask visitors before they touch you, too.

“Isn’t it rude to ask?

No. In Washington state, many hospital health care workers are part of a program that encourages patients to ask.

What should the health care worker say?

“Thanks for asking.”

Washington State Hospital Association

Visitors to Jada Bascom’s room at Sacred Heart Children’s Hospital know they can’t get close to the baby without a trip to the sink.

Soap, water and hand sanitizer are required before anyone approaches the 5-month-old girl with the big blue eyes – and a diagnosis of acute myeloid leukemia. A stray germ could lead to a life-threatening infection, Kyle and Issa Bascom, Jada’s parents, said Monday.

“We have to tell everybody, all our friends,” Issa Bascom said. “If they come in, they wash and sanitize before they touch anything.”

The warning holds for doctors, nurses and other workers, too, under terms of an innovative hygiene program that encourages patients to remind everyone – including caregivers – to wash their hands, still the best way to prevent infections.

While that thought might intimidate some people, the Bascoms said they got over it months ago.

“It’s more important to take care of her than to worry about hurting someone’s feelings,” said Issa Bascom.

Washington is the first state in the nation to ask its hospitals to collaborate in a program that monitors hand hygiene by measuring the amount of soap and sanitizer caregivers use, said Carol Wagner, vice president for patient safety for the state’s hospital association. Oregon is set to follow soon.

Since early 2006, 46 of the state’s 97 hospitals have agreed to track usage, and also to encourage patients to speak up about hand washing.

Since then, participating hospitals have increased hand sanitation by nearly a quarter in most units and by nearly three-quarters in intensive care units, according to early analysis by Maryanne McGuckin, the former University of Pennsylvania researcher who created the program.

In Spokane, Sacred Heart Medical Center, Holy Family Hospital and St. Luke’s Rehabilitation Institute have joined the effort, with positive results, said Roy Almeida, Sacred Heart’s epidemiologist.

“We did see a big improvement,” Almeida said. “In some areas we were at least able to double our rate.”

McGuckin’s plan, devised a decade ago, was among the first to offer an objective measure of hospital hand hygiene. Other methods include direct observation and peer reviews of behavior, but those have obvious drawbacks, the researcher said in a telephone interview Monday.

“Are the hospital workers going to tell on each other?” she said.

Instead, McGuckin and fellow researchers crafted a formula that designated the number of times a caregiver should see a patient each day and figured the amount of soap that would be used. It’s a program implemented in more than 300 hospitals nationwide before Washington signed on.

In an intensive care unit, for instance, the goal would be 144 hand-washing opportunities per patient per day. In a non-ICU unit, where patients aren’t as sick, the goal would be 72 uses per patient per day.

“Then you tell them how much soap you used,” Almeida explained. “Before we started, it’s not like we weren’t washing our hands.”

The baseline use at Sacred Heart was about 80 percent of the goal, Almeida said. After nearly two years of education, posters, brochures and table-top reminders, some units have topped 130 percent.

Hospitals across Washington have seen similar results. At Harborview Medical Center in Seattle, ICU rates have risen to 78 percent of the goal, said Dr. Tim Dellit, medical director of infection control. In March, one unit at the hospital reached 149 percent of compliance, he said.

The hand hygiene program encountered an unexpected political glitch in April, when McGuckin’s research arrangement with the University of Pennsylvania and STERIS Corp., an Ohio maker of medical soap and sanitizers, broke up. McGuckin said she retired after funding fell following a dispute about licensing her research methods. She left to work full time for her private, for-profit company, McGuckin Methods International. Representatives from the university and STERIS did not immediately return calls about the matter Monday.

In Washington, the hospital association decided not to join McGuckin’s private firm, said Wagner, who would not say why. Instead, the association decided to use its staff to track compliance rates. That concerned McGuckin, who commended Washington for continuing to focus on hand hygiene but said she doubted that the state workers could maintain the complicated data needed to produce accurate compliance figures.

“Benchmarking is not just putting numbers on a graph,” she said.

Wagner said workers would continue to use McGuckin’s calculations.

In any case, the formula is only a rough estimate of hand hygiene improvement, said Dellit.

“I’m not sure that the absolute number, 78 percent, 68 percent, 84 percent, is the important thing,” he said. “Overall, our rates have gradually gone up.”

That’s vital because health care workers easily can pass infection from one patient to another, leading to serious illness, even death. One of the most serious infections in hospitals, Methicillin-Resistant Staphylococcus Aureus, or MRSA, is spread solely thorough direct contact.

“You can make an argument that hand hygiene is the cornerstone of infection control,” said Dellit, who has studied ways to combat MRSA. “And it’s cost-effective. You can’t get more bang for your buck.”

Asking patients to become proactive about hand hygiene is an important step in battling infection, but it can be difficult to broach some social barriers.

“People in general are not used to questioning their doctors, nurses or providers,” Dellit noted. “It’s intimidating.”

The goal is to change that notion, McGuckin said. A big part of the program is encouraging patients to ask caregivers to wash up – without fear of being rejected.

“Our research shows that 80 percent to 90 percent of people say they will ask, but it’s actually around 70 percent who do,” McGuckin said. “What we’ve found is what they needed was permission.”

That’s easy to provide, said Monica Phipps, a registered nurse in the pediatric hematology and oncology department at Sacred Heart Children’s Hospital.

Although staffers in a children’s cancer center have long been vigilant about hand washing, Phipps said she wouldn’t mind at all if a patient or a family member spoke up.

“I’d feel just fine about it,” she said. “I might say, ‘I just washed my hands in the hall, but I’d be happy to wash again.’ Sometimes you do need a reminder.’ ”

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