five years
100 safecare hospitals
recognizing healthcare excellence
featured hospitals
2015 100 safecare hospitals
2016 100 safecare hospitals
2017 100 safecare hospitals
methodology in action
hospital spotlight
singapore general hospital
The World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy comprising a Guide to Implementation and a range of tools constructed to facilitate implementation of each component was used in a 1600-bedded acute tertiary care general hospital in Singapore. The objective is to change healthcare workers’ behavior and improve hand hygiene compliance. During the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, a high compliance of close to 90% in healthcare workers to hand hygiene was achieved. However, this was primarily driven by fear for transmission of pathogens to self. Following the closure of the SARS outbreak globally, we noted that the hand hygiene compliance decreased to that of the baseline before the SARS outbreak i.e. the high hand hygiene compliance was not sustainable.
The hand hygiene program was revised in early 2007 following Singapore’s signing of the pledge to the WHO “Clean Care is Safer Care” program. The multi-prong approach used includes:
1. System change:
a. Alcohol based hand rub was promoted for routine use of hand hygiene instead of the previous 4% chlorhexidine hand wash. During SARS, alcohol hand rub bottles were installed at the foot of every patient bed and all lift lobbies in an attempt to enable easy access by healthcare workers to hand hygiene products. From 2007, more alcohol hand rub bottles were installed along ward corridors and near food establishments in the hospital ground.
b. Following the review of the WHO Hand Hygiene Manual (Advanced Draft 2006), the Infection Control Committee approved the use of at least either ethanol 80% or isopropyl alcohol 75% in the procurement of hand hygiene alcohol hand products. This implies the use of a higher content of alcohol than before. From July 2009, 4% chlorhexidine hand wash agent bottles were removed from the clinical areas except for the Operating Theatres, Endoscopy Unit and Treatment rooms. This was done to reduce the incidence of dryness or skin irritation resulting from concomitant use of both alcohol and chlorhexidine. 1 Hand moisturizer was provided freely for healthcare workers’ use. They are encouraged to use it as often as possible to protect their hands.
The hand hygiene program was revised in early 2007 following Singapore’s signing of the pledge to the WHO “Clean Care is Safer Care” program. The multi-prong approach used includes:
1. System change:
a. Alcohol based hand rub was promoted for routine use of hand hygiene instead of the previous 4% chlorhexidine hand wash. During SARS, alcohol hand rub bottles were installed at the foot of every patient bed and all lift lobbies in an attempt to enable easy access by healthcare workers to hand hygiene products. From 2007, more alcohol hand rub bottles were installed along ward corridors and near food establishments in the hospital ground.
b. Following the review of the WHO Hand Hygiene Manual (Advanced Draft 2006), the Infection Control Committee approved the use of at least either ethanol 80% or isopropyl alcohol 75% in the procurement of hand hygiene alcohol hand products. This implies the use of a higher content of alcohol than before. From July 2009, 4% chlorhexidine hand wash agent bottles were removed from the clinical areas except for the Operating Theatres, Endoscopy Unit and Treatment rooms. This was done to reduce the incidence of dryness or skin irritation resulting from concomitant use of both alcohol and chlorhexidine. 1 Hand moisturizer was provided freely for healthcare workers’ use. They are encouraged to use it as often as possible to protect their hands.
|
2. Training & education:
a. WHO training DVDs were used to illustrate clinical scenarios of hand hygiene opportunities to all healthcare workers. Although these were in French, they provided clear teaching on the 5 moments to the staffs. b. Creative educational tools were also used to teach healthcare attendants and junior nurses. Teddy bears dusted with Glo-germ were used as patient models in teaching healthcare workers the importance of hand hygiene as well as the WHO 5 moments. c. PowerPoint slides with detailed explanation of the 5 moments were created for doctors, nurses and allied health. These were uploaded on the hospital intranet for easy access by the staffs. 3. Evaluation and feedback: Feedback surveys are conducted annually amongst staffs to gather feedback and comments on products used or issues faced during practice. The last survey done in November 2010 confirmed that the use of posters have helped to remind staffs and public on the messages of hand hygiene. 4. Reminders in the workplace: More than 150 posters were designed from March 2007 for display at elevators and walkways. Giant posters on hand hygiene messaging (spanning nine floors) were designed to convey the hospital’s commitment to the public. Shuttle buses, floor surfaces and lift doors are used to display reminders to both staffs and public . |
|
5. Institutional safety climate: Leadership’s support and commitment was clearly visible at events and meetings. The Chief Executive Officer (CEO) led the hospitals staffs in November 2009 in a pledge of commitment to the Hand Hygiene Program.
Hand hygiene compliance rate improved from 20% (in January 2007) to 61% (2010). Improvement was also seen annually in the compliance to each of the 5 moments as well as in all staff categories. Although hand hygiene compliance was lowest in the doctors’ category, it is encouraging to note that improvement was also seen year to year in this job category. The hand hygiene program was an integral part also of an ongoing MRSA reduction program in the hospital, which includes the implementation of the MRSA bundle. |
|
The “MRSA bundle” includes five components of care. This bundle was first introduced by the Institute of Healthcare Improvement (IHI) in 2006 in their “Protecting 5 Million Lives from Harm” campaign. It comprised the following elements:
1. Hand Hygiene
2. Decontamination of the environment/equipment
3. Active surveillance cultures
4. Contact precautions for infected and colonized patients
5. Device bundles (CLABSI, CAUTI, and VAT bundles)
1. Hand Hygiene
2. Decontamination of the environment/equipment
3. Active surveillance cultures
4. Contact precautions for infected and colonized patients
5. Device bundles (CLABSI, CAUTI, and VAT bundles)
|
Most of the elements were routine practices in the hospital except for active surveillance cultures, which were implemented hospital-wide for high risk patient groups from 2008. Healthcare-associated MRSA infections were noted to reduce from 0.6 (2007) to 0.3 (2010) per 1000 patient-days. Leadership’s support of the program evidenced through visible leadership presence, messaging and release of resources is the key factor in helping to make the program a true success. The hospital was recognized as a Global Hand Hygiene Expert Centre in January 2011. The use of the WHO multi-prong interventions is successful in improving hand hygiene compliance with concomitant reduction in healthcare associated infections.
|
parrish medical center
Parrish Medical Center (PMC) is a public, not-for-profit, 210-bed acute care hospital located within sight of the launch towers of Kennedy Space Center in Titusville, Florida. A Mayo Clinic Care Network member and one of the nation’s most recognized hospitals for clinical quality, patient safety and healing environments, PMC has served Brevard County for nearly 60 years. Parrish continues to achieve a level of excellence on par with the nation’s very best hospitals. Just this year, PMC established Parrish Healthcare, a groundbreaking network of healthcare providers certified by The Joint Commission as the nation’s first Integrated Care Network. Parrish Healthcare includes Parrish Medical Center, Parrish Medical Group, and Florida Health, a regional network of health providers and insurers.
|
Though honors and accolades were never the end goal in carrying out its mission Parrish Healthcare has naturally become recognized among America’s finest healing environments. Among its many accolades:
|
|
- The Joint Commission awarded PMC the first ever certification for Integrated Care and has consistently recognized PMC as a Top Performer on Key Quality Measures, as well as awarding multiple disease-specific Gold Seal advanced certifications, including for Primary Stroke.
|
Groundbreaking Integrated Care Certification
In January 2016, Parrish Medical Center earned the nation’s first Joint Commission integrated care certification and announced the formation of Parrish Healthcare, a regional network of integrated care partners. Parrish Healthcare includes Parrish Medical Center; Parrish Medical Group, NCQA-certified as a patient-centered medical home; and Florida Health Network®, a regional network of healthcare providers, insurers and others, including the Mayo Clinic in Jacksonville, Florida, working collaboratively to improve quality and safety while lowering healthcare costs on behalf of individuals, families and businesses. |
“Unlike most models that build fragmented networks through mergers and acquisitions, Parrish Healthcare’s model is one of collaboration among health and healthcare organizations with the patient and his or her personal health and wellness goals at the center of that collaboration,” said George Mikitarian, president and CEO of Parrish Healthcare. “We are proud to be the nation’s first to earn Integrated Care Certification. We wanted a tough, objective measure of our integrated care effectiveness. Completing the voluntary certification process continues to afford us the opportunity to demonstrate that our community-based network of hospitals, physicians and outpatient services are effectively working together to improve patient care and quality and to reduce costs.”
|
“We have dedicated ourselves years before the passing of the Affordable Care Act to the goal of transforming how we provide health-related services, healthy living initiatives, as well as safe, high quality and healing care, in direct cooperation with the people we serve,” added Mikitarian.
PMC believes that goal is best achieved through integration, coordination and collaboration of health-related care programs throughout the individual’s life. “Collaboration has been one of our strategic initiatives well before the enactment of the Affordable Care Act. The Integrated Care Certification validates what we’ve been doing for a long time,” said Mikitarian. |
|
