Karen Smith, nursing director at Central Illinois Endoscopy Center in Peoria, says a random auditing of the facility's compliance to infection control practices and increased regulations on infection control caused her to implement new best practices for improved infection control. She shares six quick tips ASCs can adopt to increase compliance to hand hygiene and other infection control measures.
1. Make antibacterial hand sanitizers readily accessible. After observing a low percentage of physicians and staff members at Central Illinois Endoscopy were actually using hand sanitizers, Ms. Smith installed hand sanitizer pumps along the walls of every room in the facility.
"Every single cubicle and every single room now has a hand sanitizer," she says. "The expectation is that I don't care what you go in a room for. If you step into a room, you're going to use the hand sanitizer once you go inside and once you come out."
2. Put up visible signage. Ms. Smith and the medical director made posters about the hand washing protocols established by the Centers for Disease Control and Prevention and taped them to the walls of the facility. Not only were signs put up to encourage stricter compliance, but each physician and employee also received hard copies of the CDC guidelines. One measure physicians were not complying to, Ms. Smith says, was the regulation of washing hands with soap and water after taking off latex gloves.
"Some of the signs we put up for the physicians were 'Make sure you wash your hands after you take off your gloves' and 'Are you gellin'?' in big bold letters," she says. "We adopted the Dr. Scholl's campaign for the shoe inserts. It's corny, but it works. Once we did that, we all of a sudden saw compliance was really high."
3. Audit physicians and staff members on compliance. By auditing physicians and staff members on how compliant they are to hand hygiene, ASCs can make better-informed decisions on how to carry out new protocols and regulations. Ms. Smith audited Central Illinois Endoscopy's physicians and staff by observing and tallying how many times each individual washed his or her hands out of every 10 times. By the end of the audit, she found a very low percentage of them were following hand hygiene rules.
"I took some work out to the main nurses' station where I could pretty much see everything that was going on and simply pretended to work," she says. "I had a tally sheet so I was able to tell in my report out of every 10 times how often a physician or staff member was washing their hands. Staff members and physicians weren't understanding that even if they go into a cubicle for one minute or pass a curtain that divides patient recovery areas, they still have to be compliant to hand hygiene protocol."
4. Set up a system of secret monitors. For increased monitoring, Ms. Smith instated a system where secret monitors would watch for hand hygiene compliance in the three main areas of the ASC: the outpatient area, procedure room and recovery room. In each area, she elected one staff member to tally and document whether other staff members and physicians were following hand hygiene protocol.
"Our nurse can sit in the recovery area, where she typically sits at a desk ordering medication, tests and so on, but she can still see everyone," Ms. Smith says. "In the procedure room, the nurse assisting in the procedure would make sure everyone gelled with hand sanitizer before coming into the room and every physician washed his or her hands after taking off their gloves. She would watch that and tally compliance. In the outpatient area, it's just one nurse watching the other and making sure nurses coming in from the procedure room are being compliant as well."
5. Clean the rooms and equipment at the end of the day. Central Illinois Endoscopy has made a habit of cleaning, flushing and sterilizing every scope between procedures. Additionally, staff members use stickers that are marked with dates to show when certain supplies have been opened, which helps staff members avoid the potential of using supplies that have been open for too long.
"At the end of every day, we make sure everything's thrown away properly and cleaned up," Ms. Smith says. "Also, to make double sure someone hasn't forgotten to dispose of something that's old, there are stickers on everything. So every time a staff member has to open a supply, there are pre-printed stickers with the staff member's name, time and date. Putting that on the object ensures they aren't using something that's been out for too long, like sterile water. Staff member would just have to look at the printed sticker at the bottom of the water basin."
6. Conduct yearly competency test on proper equipment maintenance. In addition to having representatives from various equipment companies come in to assist in yearly competency meetings, ASCs could also benefit from testing staff members on their knowledge on a regular basis. Ms. Smith says she strives to make sure every single staff member knows how to do as much as possible, including scope cleaning, so that the ASC can run in a more efficient and infection control-driven manner.
"Every morning, whoever is assigned to the scope room for that day is responsible for testing the quality controls on the chemicals and instruments to make sure they're working correctly and the sterilization liquids are okay," she says. "It can be a technician or a nurse, but whoever it is, they also have to log into a book which I check daily that all the testing on scopes and equipment were done for that day."
Learn more about Central Illinois Endoscopy Center.
1. Make antibacterial hand sanitizers readily accessible. After observing a low percentage of physicians and staff members at Central Illinois Endoscopy were actually using hand sanitizers, Ms. Smith installed hand sanitizer pumps along the walls of every room in the facility.
"Every single cubicle and every single room now has a hand sanitizer," she says. "The expectation is that I don't care what you go in a room for. If you step into a room, you're going to use the hand sanitizer once you go inside and once you come out."
2. Put up visible signage. Ms. Smith and the medical director made posters about the hand washing protocols established by the Centers for Disease Control and Prevention and taped them to the walls of the facility. Not only were signs put up to encourage stricter compliance, but each physician and employee also received hard copies of the CDC guidelines. One measure physicians were not complying to, Ms. Smith says, was the regulation of washing hands with soap and water after taking off latex gloves.
"Some of the signs we put up for the physicians were 'Make sure you wash your hands after you take off your gloves' and 'Are you gellin'?' in big bold letters," she says. "We adopted the Dr. Scholl's campaign for the shoe inserts. It's corny, but it works. Once we did that, we all of a sudden saw compliance was really high."
3. Audit physicians and staff members on compliance. By auditing physicians and staff members on how compliant they are to hand hygiene, ASCs can make better-informed decisions on how to carry out new protocols and regulations. Ms. Smith audited Central Illinois Endoscopy's physicians and staff by observing and tallying how many times each individual washed his or her hands out of every 10 times. By the end of the audit, she found a very low percentage of them were following hand hygiene rules.
"I took some work out to the main nurses' station where I could pretty much see everything that was going on and simply pretended to work," she says. "I had a tally sheet so I was able to tell in my report out of every 10 times how often a physician or staff member was washing their hands. Staff members and physicians weren't understanding that even if they go into a cubicle for one minute or pass a curtain that divides patient recovery areas, they still have to be compliant to hand hygiene protocol."
4. Set up a system of secret monitors. For increased monitoring, Ms. Smith instated a system where secret monitors would watch for hand hygiene compliance in the three main areas of the ASC: the outpatient area, procedure room and recovery room. In each area, she elected one staff member to tally and document whether other staff members and physicians were following hand hygiene protocol.
"Our nurse can sit in the recovery area, where she typically sits at a desk ordering medication, tests and so on, but she can still see everyone," Ms. Smith says. "In the procedure room, the nurse assisting in the procedure would make sure everyone gelled with hand sanitizer before coming into the room and every physician washed his or her hands after taking off their gloves. She would watch that and tally compliance. In the outpatient area, it's just one nurse watching the other and making sure nurses coming in from the procedure room are being compliant as well."
5. Clean the rooms and equipment at the end of the day. Central Illinois Endoscopy has made a habit of cleaning, flushing and sterilizing every scope between procedures. Additionally, staff members use stickers that are marked with dates to show when certain supplies have been opened, which helps staff members avoid the potential of using supplies that have been open for too long.
"At the end of every day, we make sure everything's thrown away properly and cleaned up," Ms. Smith says. "Also, to make double sure someone hasn't forgotten to dispose of something that's old, there are stickers on everything. So every time a staff member has to open a supply, there are pre-printed stickers with the staff member's name, time and date. Putting that on the object ensures they aren't using something that's been out for too long, like sterile water. Staff member would just have to look at the printed sticker at the bottom of the water basin."
6. Conduct yearly competency test on proper equipment maintenance. In addition to having representatives from various equipment companies come in to assist in yearly competency meetings, ASCs could also benefit from testing staff members on their knowledge on a regular basis. Ms. Smith says she strives to make sure every single staff member knows how to do as much as possible, including scope cleaning, so that the ASC can run in a more efficient and infection control-driven manner.
"Every morning, whoever is assigned to the scope room for that day is responsible for testing the quality controls on the chemicals and instruments to make sure they're working correctly and the sterilization liquids are okay," she says. "It can be a technician or a nurse, but whoever it is, they also have to log into a book which I check daily that all the testing on scopes and equipment were done for that day."
Learn more about Central Illinois Endoscopy Center.