Managing Infection Rates

Howick Baptist Healthcare is an 80 bed aged care hospital (high care aged care facility) located in the North Island of New Zealand. It commenced benchmarking its performance outcomes with QPS in Quarter 2, 2006. Quality/Infection Control Coordinator Lyn Ramsay believes that benchmarking has enabled staff to drive improvements from the ground floor up rather than the other way around. Recent improvements in the organisation's Urinary Tract Infection (UTI) rates indicate the benefits of this approach.

An important feature of the benchmarking process at Howick is that all reports are displayed on the notice board for all staff to see and review. Unexpected variations from time to time draw comments and questions from staff.The collection and reporting of data that pointed towards an increasing UTI rate drew the attention of both management and staff.

In keeping with the Continuous Quality Improvement culture of the organisation it was decided to hold an `all staff' brainstorming session on the reasons for the increasing rate of UTI's. At this session all staff agreed that the outcomes being achieved were disappointing and a target of reducing the infection rate to the industry mean line or better was set.

It was interesting to note that all staff involved in the care process noted areas of deficiency and opportunities for improvement in relation to their own work practices. Nursing staff provided examples where hygiene and hand washing could be improved and other care givers noted that they could do better when it came to ensuring residents were maintaining their fluid intake. Some staff groups were self critical in respect of being vigilant at hand washing and others noted that providing fluids might be overlooked when staff were rushing off to tea or meal breaks. The openness of staff in identifying problems and seeking solutions reflects the effort that has been made to the development of a "no blame" culture of reporting at Howick Baptist Healthcare.

As a result of the brainstorming session, the following strategies were agreed:

• A renewed focus on the cleaning of key contact areas e.g. bathroom equipment, toilets.
• Responsibility for the nursing staff to observe and comment on the frequency and technique of hand washing for all care giving staff.
• Care giving staff to take personal responsibility for ensuring residents were provided fluids in sufficient quantity.
• More RN supervision of `front to back' resident washing techniques.
• Increased "walk around" supervision from the Quality/Infection Control Coordinator
• Introduction of carafes of water on dining room tables for the residents who are able to manage.
• Responsibility given to each care giver to report any observed exceptions to correct process.
• Introduction of afternoon duty staff checking and replenishing of fluids at the start of their shift.

In addition to these immediate strategies the following longer term strategies were also discussed, noted and considered.

• Introduction of steam cleaning systems with a particular focus on steam cleaning of shower chairs. This is currently being trialled.
• A planned refurbishment program that could improve bathroom and toilet facilities and bathroom / resident ratios.

Initial results are showing good improvement with the UTI rate over the past six months being approximately 50% of the rate of the previous nine months.