how to improve compliance with infection control
TRANSCRIPT
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…atleastItry
¤ 24hospitalsintheNL(ICUs&surgery)
¤ 19%overallcompliance
² 3%before² 22%aGer
¤ NodifferencebetweenRNenMD
¤ SmallerhospitalsbeOerthanbigger
VickyErasmusInfControlHospEpidemiol2009
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¤ Welook,othersdon’t…¤ Oursurveillanceistoogood(noHawthorneeffect)…
¤ NoonecandobeOer…¤ FiveindicaYonsare(two)toomany…
¤ Handhygieneisonlyoneofthemeasures…
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hOp://www.hha.org.au/LatestNaYonalData.aspx
Whydon’ttheylistentoInfecYonControl?
Policing One-trackmind
Guidelines
Guidelines
Guidelines
Guidelines
Moreguidelines
…&moreESBLCREMRSAMDR-ABXDR-TBPRPMERS-CovC.difNoroFluLA-MRSACNR-GNRSARSFungiCR-ESCOCA-MRSATBC…
Please,nomore!
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ICneedstobeto-the-point
MRSA
ESBL
C.dif&Co
CRE
…..
HAI-prevenYon
CommunicaYon
¤ Structure&design¤ Knowwhy¤ Learningfromothers
¤ Structure&design¤ Knowwhy¤ Learningfromothers
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¤ IntuiYve
¤ Clear
¤ SeducYve
¤ Force?
¤ Award
Mirrorinelevator
² Moreroom
² Changeofbehavior
¤ Structure&design¤ Knowwhy¤ Learningfromothers
StandardHospital
Weareagreathospital
Gooddoctors,Caringnurses…
Trustus!
We“care`’aboutthephysicalandmentalhealthofourpaYents
Wedosobyensureeasy
access,onestopshop,andahealing
environment
Whichhappenstomakeusagreat
hospital.Trustus?
YourHospital
Why
How
What
ComputerCompanyX
Wemakegreatcomputers
BeauYfuldesign,userfriendly…
buyone?
EverythingwedoWebelieveinchallenging
thestatusquo,webelievein
thinkingdifferentlyWedosobymakingourproducts
beauYfuldesigned,anduserfriendly
Whichhappenstomakegreatcomputers.Buyone?
Apple
Why
How
What
Others
Disinfectyourhands
UseABHRDoit!
Wewanttoimplementefficientand
effecYvewaystoincreaseourpaYentssafety
WeplacedABHRatthepointofcareforyouruse
Highcompliance=paYentssafety
You
SimonSinek’sGoldenCycle
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¤ NevertrieditforInfecYonControl ² your“missionstatement”couldbeconstructedlikethis² Writeitonyourwalls,screensavers,…
² usewhenteaching² usewhenarguingwiththosenon-compliant
² useinpaYentfolder
¤ Structure&design¤ Knowwhy¤ Learningfromothers
¤ High-riskindustries² commercialaviaYon² oilandgasindustry
¤ MarkeYng
¤ Behavioralscience
¤ Media
AlmostGood,MD
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…thepilotwillbeamongthedead
• Education
• System change
• Motivation
Youdoagreewithmethatwedon’twantawide-spreadepidemic,don’tyou?
firstMRSAisolatewasrecoveredwithin72hofICUadmission
firstMRSAisolatedaGer72hofICUadmissionP<0.01
Pre-SARS Post-SARS
SARS
ClinInfectDis2004;39:511-516
PaYentinvolvement:…theycannotandshouldnotberesponsiblefortheirownsafetyinanenvironmentoverwhichtheyhavenocontrol
George Annas NEJM 354;19:2063-2066
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• 89%ofthephotosdisplayingdoctorswere
incorrect• 31%ofthephotosdisplayingnurseswere
incorrect• Itseemsthatthestereotypeimageofa
doctordoesnotagreewiththecurrenthandhygieneguidelines.
• IfweaimforhighercompliancerateswithICmeasures,weneedtochangethesocialimageofHCWs
¤ PresenYngsomethingnewandimproveddoesnotautomaYcallychangebahavior!
¤ ‘ThelessonfrommarkeYngisthatpeoplearemorewillingtochangetheirbehaviourwhentheyfeelgood,flaOered,challengedpowerful,sexyorproud,thanwhentheyarefloodedwithfacts’(Hodgkin1999)
Onya,theRedskinscheerer(whoaskedthatherlastnamebewithheld,ciYngteampolicy),hasherpictureontheteam'sWebsiteinherofficialbikini-likeuniformandalsoreclininginanactualbikini.Onya,27,whodeclinedtoidenYfythecompanysheworksfor,isbutoneofseveraldrugrepresentaEveswhohavecheeredfortheRedskins
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Thusneveragainsaythatthe
majoritydoesn’tcomplywithIC
Aschconformityexperiments
¤ DoesbeOerpaymentleadstomoreeffort
¤ 600peoplewalkingbywereaskedtohelpunloadingasofafromatruck² GroupA:“justasked”² GroupB:“offered50centahead”² WillingnesstohelpingroupBsignificantlylower
² WillingnessofgroupBonlycomparabletogroupAat$5
¤ Praise>>Money,andwecannotaffordtopayforbeOercompliance
HeymanJ,ArielyD.PsycholSci2004;15:787-793
www.sciencexpress.org/20November2008/Page1/10.1126/science.1161405
§ Orderlyalley:33%liOering§ GraffiYalley:§ 69%liOering
¤ whenpeopleobserveinappropriatebehavior,thisweakenstheirconcernforappropriateness
§ Orderlyalley§ NograffiYsign§ Flyeronhandlebar§ avoidliOering
Weneed“order”inourhospitalsandpeopleshowingappropriatebehavior!
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¤ AninnocentassociaYonwitheitherbadorgoodthingswillinfluencehowpeoplefeelaboutusoraproduct² Thegoodlookingmodelsnexttothecar² RaYngofidenYcalcarchangedwithandwithoutmodel
² Mendidn’tbelievethattheirjudgmentwasinfluenced
§ Culture change (CEO directive and save/open communication)
§ State your motivation (“why”) § Better design § Patient’s involvement § Media support § A (supportive) inspectorate