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Hand Hygiene TST ®- Submit a Question

Hand Hygiene Project and the TST®


Hand Hygiene TST ®

Hand Hygiene Project and the TST®

Q:  Why should I use the Targeted Solutions Tool® hand hygiene application?

A:  TST® provides the foundation and framework for an improvement method that, if implemented well, will improve an organization’s hand hygiene compliance and contribute substantially to its efforts in reducing the frequency of health care-associated infections. Together, the leading hospitals and health care systems that developed the hand hygiene solutions have achieved and continue to show major and sustained gains in hand hygiene. At the start of the project in April 2009, they were surprised to learn that their rate of hand hygiene compliance averaged 48 percent. By June 2010 they had reached an average rate of 82 percent that had been sustained for eight months. Many other hospitals across the country – small, medium and large – collaborated with the Center to test the work of the original eight hospitals and provide guidance on the development of the TST® for Hand Hygiene. These hospitals experienced the same gains as the original eight.
 

Q:  How long will a hand hygiene project take to complete?

A:  The duration of a hand hygiene project varies from organization to organization. Hand hygiene projects have generally lasted from six to 12 weeks depending on the resources and experience of the organization.

 

Q:  How many staff members should be on a hand hygiene project team?

A:  A core team of three to seven people is recommended. 

Q: How much staff time and commitment will a hand hygiene project require?

A:  You will need to obtain management support for your project and assemble a project team. Project teams can be expected to spend up to four hours a week collecting and entering compliance data, attending team meetings, and implementing solutions during the first 12 weeks of the project. You can expect to spend four hours each month to sustain the gains achieved by the hand hygiene improvement strategies.
 

Q:  What type of staff should be on a hand hygiene project team?

A:  The hand hygiene team should include a strong physician champion and a project leader to facilitate meetings and help gain buy-in from stakeholders. Include the manager of the pilot unit and people who work in the area, including ancillary staff, when appropriate (for example, housekeeping, lab, respiratory therapy). It is important to identify and consider the project stakeholders.

Q:  Why is hand hygiene defined as “wash in/wash out?”

A:  Observation was chosen as the method to determine baseline and post-solution hand hygiene compliance rates. However, it is nearly impossible to accurately observe hand hygiene compliance when washing occurs in a patient’s room. The Center decided to adopt the philosophy of “wash in/wash out” which directs health care personnel to wash their hands upon entry and exit from a patient’s room. This allows for accurate measurement, while still promoting the philosophy of washing before and after patient contact.

Q:  Both WHO and CDC guidelines address hand hygiene when a health care worker touches a patient or the environment and this is what our policy reflects. How do we reconcile this with "wash in, wash out?"

A:  The concept of “wash in and wash out,” which is part of the approach and the solutions described in the Targeted Solutions Tool®, describes a minimum number of times a health care worker should conduct hand hygiene when entering and exiting a patient’s room. If patient care necessitates the additional washing of hands (more than that required with “wash in, wash out”) this should be done in accordance with WHO or CDC hand hygiene guidelines.

Q:  What is a project charter?

A:  A project charter puts in writing the scope, team members, goals and completion dates of the hand hygiene pilot project. The project charter is signed by the project team members as a demonstration of their support for the project and their agreement on the project’s goals and scope.

Q: CDC and WHO guidelines indicate that health care personnel should wash their hands before and after patient contact. Why did the Center and participating hospitals decide to measure compliance upon entry to and exit from a patient’s room?

A: The collaborating organizations chose observation as the method to determine baseline and post-solution compliance rates. However, it is nearly impossible to accurately observe hand hygiene compliance when washing occurs in a patient’s room. The organizations decided to uniformly adopt the philosophy of “wash in – wash out,” whereby health care personnel are directed to wash their hands upon entry and exit from a patient’s room. This allows for accurate measurement, while still promoting the philosophy of washing before and after patient contact.

Q: Did the collaborating organizations measure and seek to improve the hand washing compliance of patients and visitors?

A: The Center’s project excluded measuring compliance of patients and visitors. CDC and WHO guidelines are directed toward health care personnel (HCP) only. The CDC definition of HCP excludes patients, family members and other visitors, but does include students, volunteers and other health care workers with direct patient contact. Studies have shown a greater risk of disease transmission from health care personnel compared to non-health care personnel such as patients and family members.

Q: Did the organizations attempt to reduce infections related to the use of medical equipment such as stethoscopes or clothing (e.g., lab coats and ties)?

A: The scope of this Center project did not include assessing the adequacy of procedures for disinfecting medical equipment or evaluating the impact of clothing of caregivers on transmissibility of infection. There are multiple factors that contribute to the effectiveness of infection prevention and control programs. Improving other aspects of infection prevention and control will be the focus of future Center projects.

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