Published on March 17, 2016
1. 16-03-16 1 … at least I try ¤ 24 hospitals in the NL (ICUs & surgery) ¤ 19% overall compliance ² 3% before ² 22% aGer ¤ No diﬀerence between RN en MD ¤ Smaller hospitals beOer than bigger Vicky Erasmus Inf Control Hosp Epidemiol 2009
2. 16-03-16 2 ¤ We look, others don’t … ¤ Our surveillance is too good (no Hawthorne eﬀect) … ¤ No one can do beOer … ¤ Five indicaYons are (two) too many … ¤ Handhygiene is only one of the measures …
3. 16-03-16 3 Source: Health ProtecYon Scotland, January 2013 They are both (or the car, will be soon) full-of-sh…
4. 16-03-16 4 hOp://www.hha.org.au/LatestNaYonalData.aspx Why don’t they listen to InfecYon Control? Policing One-track mind Guidelines Guidelines Guidelines Guidelines More guidelines … & more ESBL CRE MRSA MDR-AB XDR-TB PRP MERS-Cov C.dif Noro Flu Please, no more!
5. 16-03-16 5 IC needs to be to-the-point MRSA ESBL C.dif & Co CRE ….. HAI - prevenYon CommunicaYon ¤ Structure & design ¤ Know why ¤ Learning from others ¤ Structure & design ¤ Know why ¤ Learning from others
6. 16-03-16 6 ¤ IntuiYve ¤ Clear ¤ SeducYve ¤ Force? ¤ Award Mirror in elevator ² More room ² Change of behavior ¤ Structure & design ¤ Know why ¤ Learning from others Standard Hospital We are a great hospital Good doctors, Caring nurses… Trust us! We “care`’ about the physical and mental health of our paYents We do so by ensure easy access, one stop shop, and a healing environment Which happens to make us a great hospital. Trust us? Your Hospital Why How What Computer Company X We make great computers BeauYful design, user friendly … buy one? Everything we do We believe in challenging the status quo, we believe in thinking diﬀerently We do so by making our products beauYful designed, and user friendly Which happens to make great computers. Buy one? Apple Why How What Others Disinfect your hands Use ABHR Do it! We want to implement eﬃcient and eﬀecYve ways to increase our paYents safety We placed ABHR at the point of care for your use High compliance = paYents safety You Simon Sinek’s Golden Cycle
7. 16-03-16 7 ¤ Never tried it for InfecYon Control ² your “mission statement” could be constructed like this ² Write it on your walls, screen savers, … ² use when teaching ² use when arguing with those non-compliant ² use in paYent folder ¤ Structure & design ¤ Know why ¤ Learning from others ¤ High-risk industries ² commercial aviaYon ² oil and gas industry ¤ MarkeYng ¤ Behavioral science ¤ Media Almost Good, MD
8. 16-03-16 8 … the pilot will be among the dead • Education • System change • Motivation You do agree with me that we don’t want a wide-spread epidemic, don’t you? ﬁrst MRSA isolate was recovered within 72 h of ICU admission ﬁrst MRSA isolated aGer 72 h of ICU admission P < 0.01 Pre-SARS Post-SARS SARS Clin Infect Dis 2004;39:511-516 PaYent involvement: … they cannot and should not be responsible for their own safety in an environment over which they have no control George Annas NEJM 354;19:2063-2066
9. 16-03-16 9 • 89% of the photos displaying doctors were incorrect • 31% of the photos displaying nurses were incorrect • It seems that the stereotype image of a doctor does not agree with the current hand hygiene guidelines. • If we aim for higher compliance rates with IC measures, we need to change the social image of HCWs ¤ PresenYng something new and improved does not automaYcally change bahavior ! ¤ ‘The lesson from markeYng is that people are more willing to change their behaviour when they feel good, ﬂaOered, challenged powerful, sexy or proud, than when they are ﬂooded with facts’ (Hodgkin 1999) Onya, the Redskins cheerer (who asked that her last name be withheld, ciYng team policy), has her picture on the team's Web site in her oﬃcial bikini- like uniform and also reclining in an actual bikini. Onya, 27, who declined to idenYfy the company she works for, is but one of several drug representaEves who have cheered for the Redskins
10. 16-03-16 10 Thus never again say that the majority doesn’t comply with IC Asch conformity experiments ¤ Does beOer payment leads to more eﬀort ¤ 600 people walking by were asked to help unloading a sofa from a truck ² Group A: “just asked” ² Group B: “oﬀered 50 cent ahead” ² Willingness to help in group B signiﬁcantly lower ² Willingness of group B only comparable to group A at $5 ¤ Praise >> Money, and we can not aﬀord to pay for beOer compliance Heyman J, Ariely D. Psychol Sci 2004;15:787-793 www.sciencexpress.org / 20 November 2008 / Page 1 / 10.1126/science.1161405 § Orderly alley: 33% liOering § GraﬃY alley: § 69% liOering ¤ when people observe inappropriate behavior, this weakens their concern for appropriateness § Orderly alley § No graﬃY sign § Flyer on handlebar § avoid liOering We need “order” in our hospitals and people showing appropriate behavior !
11. 16-03-16 11 ¤ An innocent associaYon with either bad or good things will inﬂuence how people feel about us or a product ² The good looking models next to the car ² RaYng of idenYcal car changed with and without model ² Men didn’t believe that their judgment was inﬂuenced § Culture change (CEO directive and save/open communication) § State your motivation (“why”) § Better design § Patient’s involvement § Media support § A (supportive) inspectorate
Communication interventions to improve adherence to infection control precautions: a randomised ... Compliance with infection control ...
Improving Compliance With Hand Hygiene ... Kretzer EK, Larson EL. Behavioral interventions to improve infection control practices. Am J Infect Control ...
1. Lancet. 2000 Oct 14;356(9238):1307-12. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.
Effectiveness of a hospital-wide programme to improve ... and the members of the Infection Control Program. Compliance with handwashing in a teaching ...
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How-to Guide: Improving Hand ... the Association for Professionals in Infection Control ... Pittet D. Alcohol-based hand rub improves compliance with ...