LTCare Webinar: Hand Hygiene and Competency Validation

“Practice Makes Perfect” in Healthcare Education

Peggy Pass RN, BS, MS, CIC, FAPICNurse Manager, ICAR AssessmentsNurse Consultant, Infection Prevention & ControlMaryland Department of Health

LTCWebinar

SeriesWebinar#

5 Hand Hygiene

The ICAR Project:Infection Control Assessment and Response Project

A Collaboration between State Health Departments and the Centers for Disease Control & Prevention

What happened between 2014 – 2015?Ebola Virus Outbreaks

Antibiotic Resistance on the Rise

Both of these focused the attention of the CDC on improving the nation’s ability to combat infectious diseases effectively and quickly if necessary…

What is CDC really after?• If facilities have adopted evidence-based practices to

prevent healthcare-acquired infections• If facilities use competency-based training, audit, validation,

and feedback to ensure staff knowledge and practice• The vehicle used to find the gaps in knowledge and practice

is the ICAR Assessment • We have assessed over 32 nursing homes in Maryland• We have analyzed our data for “gaps” to use for the educational

phase of the ICAR project and our collaboration with you-our pilot group for the other roughly 200 nursing homes in Maryland

The objectives of today’s education, Hand HygieneThe learner will be able to:

1. List the three types of hand hygiene used in the LTC environment and when to use each.1. Alcohol based hand gel or foam

products2. Handwashing at the sink3. Washing hands of our residents

2. Describe the purpose of competency validation and why you think CMS has mandated this methodology for training of healthcare workers.

3. When does competency validation need to be done and what topics are mandated by CMS for this type of training? 512/14/2017

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Definition• Competency is the application of knowledge and skill in

performance. Competency is best assessed via return demonstration and observation. Additional methods include, but are not limited to, simulation, mock reviews, and case studies.

• Competency is NOT assessed via an education module with a post-test. An education module with a post-test measures knowledge, not competence (or proficiency). One may be very knowledgeable about a skill, but incompetent to actually safely perform that skill.

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CMS Surveyor Guidelines – 483.80 Infection Control

Elements of a complete program for Hand Hygiene?• List of who requires this training• Determine frequency of training-orientation & annually• Knowledge based training• Competency validation

• Demonstration of the proper way• Practice by the learner• Observation by the trainer and an assessment

• Documentation and how education records will be kept• Underlying policy –accessible, signed and reviewed annually

by IP, DON, Administrator along with strong support • Audit program with documentation and feedback mechanism

with range and accountability• Display and sharing of the real data

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https://www.cdc.gov/handhygiene/providers/training/index.html 1412/14/2017

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Hand Hygiene-not a new concept!!

• Equally acceptable -Handwashing with soap and water and hand cleansing with waterless hand sanitizer gel

• Hand hygiene is recognized as the most important prevention measure to help reduce the spread of infections - in the hospital, at home, at day care, everywhere

Any individual whose responsibilities include direct hands-on patient care may only have natural fingernails. No artificial fingernails or nail enhancements, including but not limited to overlays, wraps, tips or attached decorations are permitted.

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Hand Hygiene Audit Record

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Hand Hygiene Audit page 2

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Hand Hygiene Audit page 3

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Sample Graphic Representation of Hand Hygiene Audits

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50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Perc

ent C

ompl

ianc

e

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14 Jul-14 Aug-

14Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

All Staff 89% 94% 95% 93% 91% 92% 91% 91% 94% 89% 89% 94% 91% 91% 91% 90% 86% 89%RNs 91% 95% 96% 92% 90% 96% 90% 92% 96% 89% 88% 94% 93% 93% 95% 90% 89% 91%MDs 82% 82% 86% 82% 87% 91% 82% 81% 90% 88% 85% 85% 77% 82% 83% 85% 76% 82%Other 88% 96% 96% 95% 94% 88% 83% 93% 93% 88% 91% 97% 92% 91% 90% 90% 87% 92%Numerator 682 834 944 1,023 929 776 910 773 878 913 851 819 833 816 1,054 1,023 1,110 915Denominator 765 885 998 1,103 1,017 844 1,000 846 936 1,031 954 868 911 900 1,152 1,140 1,287 1,024HandStats 86% 92% 94% 93% 89% 90% 92% 90% 93% 87% 88% 91% 88% 90% 93% 87% 85% 89%

Hand Hygiene Practice Compliance -- All UnitsSAMPLE OF GRAPHIC REPRESENTATION ONLY

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36/37 38/40

68/87

28/30

30/30 30/3029/30

22/34

28/30

27/30

29/30

22/30

30/30

21/30

28/30

30/30

22/30

30/3029/30 58/60

24/45

31/3230/30

42/5024/30

39/39 60/60 30/30

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hand Hygiene Practice Compliance by UnitSAMPLE OF GRAPHIC PRESENTATION ONLY

N/D

* Dialysis, Pulm/Neuro/Sleep Lab, and Preventive Cardiology are all self-auditing

N/D

25

468/517

116/141

109/122

6/6 25/25

N/D

64/69

15/17

12/12

24/31

5/6

4/4

N/D N/D

3/3

6/9

1/1

N/D

9/12

N/D N/D

2/2 6/6

8/12

2/2

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hand Hygiene Practice ComplianceBy Employee Type – SAMPLE OF GRAPHIC REPRESENTATION

ONLY

N/D= No Data