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… not all problems are preventable Vincent  JL,  et  al.  JAMA.  2009;302(21):2323-­‐2329  

 

■   In  Europe,  51%  of  paCents  in  ICU  are  infected    

■   The  ICU  mortality  rate  of  infected  paCents            was  more  than  twice  that  of  non  infected            paCents  (25%  vs  11%,  respecCvely;  P.001),            as  was  the  hospital  mortality  rate  

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¤   Training/knowledge  ¤   CommunicaCon  ¤   Change  of  culture  ¤   PaCents  parCcipaCon  ¤   Society/media  involvement  ¤   Leadership  support  (morally  &  financial)  ¤   Hospital  structure  ¤   Rethinking  our  (IC’s)  ways  

¤   Training/knowledge  ¤   Communica)on  ¤   Change  of  culture  ¤   PaCents  parCcipaCon  ¤   Society/media  involvement  ¤   Leadership  support  (morally  &  financial)  ¤   Hospital  structure  ¤   Rethinking  our  (IC’s)  ways  

Why  don’t  they  listen  to  InfecCon  Control?  

                         Policing            One-­‐track  mind  

Guidelines  

Guidelines  

Guidelines  

Guidelines  

More  guidelines  

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IC  needs  to  be  to-­‐the-­‐point  

¤   Training/knowledge  ¤   CommunicaCon  ¤   Change  of  culture  ¤   PaCents  parCcipaCon  ¤   Society/media  involvement  ¤   Leadership  support  (morally  &  financial)  ¤   Hospital  structure  ¤   Rethinking  our  (IC’s)  ways  

¤   High-­‐risk  industries  ²   commercial  aviaCon    ²   oil  and  gas  industry    

¤   MarkeCng  

¤   Behavioral  science  

¤   Media  

Hudson  P.  Qual  Saf  Health  Care  2003;12(Suppl  1):i7–i12      

Hudson  P.  Qual  Saf  Health  Care  2003;12(Suppl  1):i7–i12      

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Almost  Good,  MD  

…  the  pilot  will  be  among  the  dead  

¤ PresenCng  something  new  and  improved  does  not  automaCcally  change  bahavior  !      

¤   …  people  are  more  willing  to  change  their  behavior  when  they  feel  good,  flafered,  challenged  powerful,  sexy  or  proud,  than  when  they  are  flooded  with  facts’   (Hodgkin  1999)  

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¤ An innocent association 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 Rating of identical car changed with and without model

² Men didn’t believe that their judgment was influenced

¤   Training/knowledge  ¤   CommunicaCon  ¤   Change  of  culture  ¤   PaCents  parCcipaCon  ¤   Society/media  involvement  ¤   Leadership  support  (morally  &  financial)  ¤   Hospital  structure  ¤   Rethinking  our  (IC’s)  ways  

¤   1600  stock-­‐photos  were      evaluated.    

¤   Most  common  mistakes  were      with  regard  to  HCWs  white      coats  and  uniforms    

¤   Of  the  photos  displaying    ² doctors  89%  were  incorrect  ² nurses  31%  were  incorrect    

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  

¤   Training/knowledge  ¤   CommunicaCon  ¤   Change  of  culture  ¤   PaCents  parCcipaCon  ¤   Society/media  involvement  ¤   Leadership  support  (morally  &  financially)  ¤   Hospital  structure  ¤   Rethinking  our  (IC’s)  ways  

¤   CEO  openly  commifed    to  IC  measures  ²   poster  with  flu  shot  ²   lefer  to  medical  staff  ²   wearing  IC  bufon  

¤   Hospital  administrator      volunteering  to  be  the      bad  messenger  

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2013   2015  

Hospital  investment  à  too  much  

2014  

Special  cleaners  “equally  good”  

New  fascility  management  à  too  much  

¤   Training/knowledge  ¤   CommunicaCon  ¤   Change  of  culture  ¤   PaCents  parCcipaCon  ¤   Society/media  involvement  ¤   Leadership  support  (morally  &  financially)  ¤   Hospital  structure  ¤   Rethinking  our  (IC’s)  ways  

"We can't solve problems by using the same kind of

thinking we used when we created them”

Albert  Einstein  

¤   Few  one-­‐page  flow-­‐charts/guidelines  ¤   IsolaCon-­‐App  ¤   Training  &  Info  Center  ¤   Combine  verCcal  and  horizontal  approaches  

²   hand  hygiene  ²   integraCon  of  IC-­‐measures  into  your  rouCne  

¤   Culture-­‐change  ²   think  infecCon  control  ²   sCck  to  the  basic  rules    

*  completely  biased  –  something  I  toy  with  but  didn’t  implement  yet  

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¤     “BRMO”  including  MRSA  ²   basic  guideline  ²   flow-­‐chart  who  to  screen    

¤   Communicable  diseases  ²   TBC  ²   Epidemic  flu  ²   …  

[i]  isolaCon  

¤   EU-­‐  and  African  version      (default  setng)  

¤   i-­‐Prevent  standard  based  on  WIP      with  regional  changes      (default  setng)  

¤   Setngs  are  fully  adjustable  to  your      local  guidelines  

¤   (Later)  nursing  home  version    

¤   Mandatory  training  for  all  new  HCWs  (2-­‐3h)  ¤   Mandatory  CME  training  infecCon  control  (1h      per  year)  for  all  HCWs  

¤   Seasonal  and  emergency  reminders  on  screens  ²   including  via  social  media  (tweets)  

¤   Info  center  ²   Online  guidelines  (not  according  to  hospital      standard,  but  pracCcal)  

²   Video-­‐clips  “How  to  …”  MRSA  

ESBL  

C.dif  &  Co  

CRE  

…..  

HAI  -­‐  prevenCon  

¤   Human  factor  engineering  ¤   DisinfecCon  methods    

²   environment  (peroxide  vapor,  UV)  ²   standardized  disinfecCons  (central  scope,  bed  washers)  ²   paCents  (chlorhexidine  wash,  STAU  erradicaCon)  

¤   AnCmicrobial  surfaces  (copper)  ¤   Checklists,  bundles  ¤   IntegraCon  of  IC  in  clinical  SOPs  ¤   Hand  hygiene    

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Same  holds  truth  for  HAI          -­‐  incubaCon  Cme  -­‐  

Asch  conformity  experiments  

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InfecCon  control  

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Single  control   ConCnious  control  

²   Ask  HCWs  what  IC  can  do  to  help  them,  instead  of        delivering    what  you  assume  they  need.    

²   AssumpCons  can  be  very  wrong!