bruce gamage, rn bsn cic ipac canada president 2014/2015 broadcast live from the 2015 congress of...
TRANSCRIPT
![Page 1: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/1.jpg)
Preventing Infections in Healthcare Workers: Strategies and Challenges
Bruce Gamage, RN BSN CICIPAC Canada President 2014/2015
Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene
Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene
www.webbertraining.com June 3, 2015
![Page 2: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/2.jpg)
I have no disclosures
I have a French name, but I don’t speak French
Disclosures
2
![Page 3: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/3.jpg)
Why don’t healthcare workers follow infection control protocols?
What hasn’t worked? What strategies have promise? Let’s talk about Ebola… Lessons learned
Outline
3
![Page 4: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/4.jpg)
Why don’t healthcare workers follow infection control protocols?
4
![Page 5: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/5.jpg)
People don’t do what they don’t have to For the most part there are no
consequences There are no immediate impacts No one is watching…
Human nature
5
![Page 6: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/6.jpg)
There is fear There is media attention E.g. SARS, H1N1, Ebola
◦ Leads to over-reaction◦ We saw very high vaccine rates during H1N1◦ HCW demanded highest level protection during
SARS and Ebola outbreaks
People follow IC when…
![Page 7: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/7.jpg)
What doesn’t work?
7
![Page 8: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/8.jpg)
We assume that if we provide healthcare workers with education they will follow the protocols
Time and time again this hasn’t worked◦ Influenza shots◦ Hand Hygiene compliance
Education
8
![Page 9: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/9.jpg)
Posters Campaigns Incentives
All have short term effects, but compliance always returns to baseline after short term improvements
Promotions
9
![Page 10: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/10.jpg)
How do we get healthcare workers to change their behaviour?
10
![Page 11: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/11.jpg)
Healthcare workers do change their behaviour based on fear and media – but this is not sustainable
Need people to understand that there is always threats to their lives…
Media campaigns can work◦ Seatbelts◦ Drunk driving◦ Cigarettes◦ Safe Sex
Resulted in cultural shift – but takes a long time
Fear/Media hype
11
![Page 12: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/12.jpg)
Loss of admitting privileges Loss of job
Has worked in some US hospitals – influenza vaccine rates of 99.9%
Punishment/Financial Penalty
12
![Page 13: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/13.jpg)
Direct observation of healthcare workers has worked to increase hand hygiene compliance
Public reporting of infection rates/hand hygiene compliance rates
Competition between units But there is the Hawthorne effect
Big Brother is Watching…
13
![Page 14: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/14.jpg)
Fundamental to getting healthcare workers to change their behaviour is addressing culture…
14
![Page 15: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/15.jpg)
Culture eats Strategy for Lunch
15
![Page 16: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/16.jpg)
Has had some success in getting improved compliance
PD doesn’t come up with new IC interventions◦ All interventions are already proven effective in
literature◦ Individuals need to come up with interventions
that work within their micro-culture PD is best applied to complex problems that
are deeply rooted in culture
Positive Deviance
16
![Page 17: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/17.jpg)
How do you know when someone has an infection?
What do you do to protect yourself and others from this infection?
What keeps you from doing this every time? Who do you know who seems to do a better
job? Does anyone have any ideas about what we
should do next?
Leading Questions…
17
![Page 18: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/18.jpg)
Let’s talk about Ebola…
18
![Page 19: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/19.jpg)
840 healthcare workers have been infected during the recent Ebola outbreak in West Africa…491 have died…
19
![Page 20: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/20.jpg)
Evidence or fear based approach? We know that Ebola is spread by droplet
and contact transmission (not airborne) But patients who are acutely ill are having
projectile vomiting and explosive diarrhea..
What’s the best approach?
20
![Page 21: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/21.jpg)
Attention to detail
21
![Page 22: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/22.jpg)
Then along came Dallas Patient travelled from Liberia Sent home initially returned with advanced symptoms and died 2 nurses infected None of his close contacts in the community
became ill
22
![Page 23: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/23.jpg)
Fear and overreaction ‘No skin in the game’ Differentiation between low transmission risk
(‘dry’) and high transmission risk (‘wet’) patients
Recognition that the greatest danger is in late stage disease with copious body fluids, particularly vomitus and bloody diarrhea
Importance of fluid impermeable PPE
IPAC changes
23
![Page 24: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/24.jpg)
Can it be ‘airborne’? Need for respirators Can we be ready everywhere? Centralized care versus regional model We will need to be prepared…
Controversies
24
![Page 25: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/25.jpg)
What have we learned?
25
![Page 26: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/26.jpg)
Educating healthcare workers doesn't get them to change behaviour
Campaigns work but are short-lived Negative consequences seem to be the
strongest motivator Healthcare workers are most likely to follow
protocols when they are afraid for their own safety
We need to effect change at a cultural level
Lessons Learned
26
![Page 27: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/27.jpg)
Questions
27
![Page 28: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/28.jpg)
www.sf2h.net/sf2h_in-english-as-well.html
![Page 29: Bruce Gamage, RN BSN CIC IPAC Canada President 2014/2015 Broadcast live from the 2015 Congress of the French Society for Hospital Hygiene](https://reader035.vdocuments.net/reader035/viewer/2022062518/56649e045503460f94aeffa0/html5/thumbnails/29.jpg)
29