4 Strategies for Discouraging Shortcuts in Infection Control
One of the challenges ambulatory surgery centers face in infection control is learning to maintain proper infection control practices without decreasing productivity or efficiency. Many infection control violations may occur because people think they do not have enough time to implement correct practices and thus take a shortcut.
Amesh A. Adalja MD, infectious disease physician and clinical assistant professor in the department of critical care medicine at the University of Pittsburgh, and Cathy Rocco, RN, MSN, CNOR, senior clinical education consultant for Advanced Sterilization Products, discuss four strategies for discouraging infection control shortcuts among staff and physicians.
1. Educate physicians and staff. Education is a key strategy in preventing shortcuts in infection control because it is critical to helping people understand the risks associated with not following protocols. "Increasing productivity is a key priority for ASC and OR staff, and unfortunately, shortcuts are often taken by staff in an effort to be as productive as possible — not realizing they could be putting patients at risk," Ms. Rocco says. "If staff are aware of why certain practices exist, they are much more apt to follow the recommendations."
She says newsletters, literature and staff meetings can be effective in educating employees and physicians on the need for infection control practices. Ms. Rocco suggests basing education on evidence-based information from organizations such as the Association for Professionals in Infection Control and Epidemiology; the Association of periOperative Registered Nurses; the Society of Gastroenterology Nurses and Associates; and the Centers for Disease Control and Prevention. "They all have specific recommendations and guidelines that support what is best for patient care," she says.
Ms. Rocco also encourages healthcare providers to use their reprocessing vendors for support in staff training and education. "At ASP, we have clinical education specialists like myself to do just that."
2. Make infection control tools available. One of the reasons physicians and staff may take shortcuts in infection control is because the tools they need are not readily accessible. For example, when a patient is in contact precautions, the physician must use a dedicated stethoscope. Dr. Adalja says if a dedicated stethoscope is not right outside the door, physicians may either take extra time to look for the stethoscope or simply use their own. "[Having] to fumble around trying to find these things makes it more difficult to comply," he says.
The same concept applies to gloves and gowns for contact precautions patients. Dr. Adalja says seeing a patient in contact precautions will always take longer than other patients because physicians need to put on new gloves, gowns and possibly masks. If physicians are forced to take additional time to look for these items because they are not readily available, the physicians may be disincentivized to follow correct infection control protocols. Similarly, alcohol sanitizers should be clearly visible and convenient for physicians and staff to use. The benefit of alcohol sanitizers is they do not require time to wash hands with soap; this time-saving factor can be effective in increasing hand sanitization compliance, Dr. Adalja says. However, if physicians and staff cannot easily find the sanitizers, this convenience will be worthless.
Dr. Adalja suggests making stethoscopes, hand sanitizers and other tools easily accessible to minimize extra time needed to practice proper infection control practices. Someone will need to inventory the infection control supplies regularly to ensure they are always available. "Just [as healthcare providers] employ custodians to make sure there is enough soap in the bathrooms, they need to be vigilant about infection control supplies," Dr. Adalja says.
3. Observe and report infection control violations. "One of the ways to make sure [physicians and staff] don't take shortcuts is to observe by reporting," Dr. Adalja says. At the University of Pittsburgh Medical Center, observers are randomly assigned to areas in the hospital to observe practices such as handwashing and using dedicated stethoscopes for patients in contact precautions. "[Having] representatives of infection control watching makes compliance [with infection control] increase," Dr. Adalja says. To ensure observation and reporting is effective in changing behavior, observers must report a violation immediately so the incident is fresh in the individual's mind, he says.
4. Empower patients. "Empowering patients to say 'Have you washed your hands?' before the doctor examines them is very powerful," Dr. Adalja says. "No doctor would not do that if a patient specifically asked [him or her] to do that." He says some hospitals have put signs in the exam room encouraging patients to ask physicians if they washed their hands.
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