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Be an Agent for Life-Saving Change

Hand Hygiene: An easy way to stop the spread of infection


In 2009 the World Health Organization (WHO) launched a global campaign called SAVE LIVES: Clean Your Hands. WHO set aside May 5 as Washing handsa day to focus on improving hand hygiene in healthcare to demonstrate the world's commitment to patient safety. This annual initiative centers on urging all healthcare workers to clean their hands thoroughly before and after patient contact. SAVE LIVES: Clean Your Hands promotes the role of hand hygiene in helping prevent potentially life threatening nosocomial infection,

By May 5, 2010 well over 10,000 healthcare facilities from over 40 countries and areas around the world had joined the campaign to act at the point of patient care. WHO insists sustaining these efforts will require dedication and innovation on the part of participating countries.

In our little corner of the world, Children's Hospital Central California Gel in Gel out signstepped up to deliver a hand hygiene program a full nine months before WHO’s global effort was born. A task force of committed professionals conceived our program in August 2008. What began as a grassroots effort in the Hospital’s pediatric intensive care unit (PICU) has swept through our entire facility, populating every patient room, entrance and hallway with Purell® dispensers emblazoned with a bright red “Gel-in, Gel-out” dot.

Diane Civiello, director of the PICU, championed the program from the start. “Hand hygiene is the easiest method of infection control,” said Nurse gels inCiviello. “Not everyone realizes how easily they can contaminate themselves and then spread infection with their hands.”

Dr. David Pugatch, medical director of infectious disease, serves on the hand hygiene committee as the physician liaison. “Hand hygiene is the fundamental, cross-cutting practice that we know helps prevent the spread of infection within the hospital,” he said. “There are other factors more complicated than hand hygiene alone, but it’s a pillar and a post.”

Children’s interdisciplinary committee of hand hygiene advocates has made tremendous progress promoting the importance of clean hands. Nurse gels inThey worked hard to help implement a new, comprehensive hand hygiene policy in November 2009. “An important part of the culture here at Children’s is an expectation that people follow the rules and the policies,” Dr. Pugatch said. The new policy includes a universal call to clean your hands before entering and upon exiting any patient room. “Hand hygiene is for all employees, not just doctors and nurses and those involved in patient care. It’s for everyone in this work environment,” he said.

The committee’s passion to ignite a wildfire of awareness began to consume them. As medical professionals, Dr. Pugatch, Civiello and their Main information desk personnel ask families to gel incolleagues navigated crowded schedules every day, but promoting and sustaining a culture of hand hygiene remained far too important to set aside. Fortunately Todd Suntrapak, Children’s executive vice president and chief operating officer, had already noticed the impact of their efforts. Suntrapak brainstormed with the committee and together they cast a vision. Suntrapak later contacted Jim Meinert, Children’s vice president of philanthropy, and encouraged him to imagine what we could do if we had $100,000.

A short time later, a philanthropist approached Meinert, and said he would like to donate $100,000 to the Hospital. Providence must have Reminder poster to clean hands or gel inbeen at work, because Meinert recalled Suntrapak’s vision. Hadn’t he requested the exact amount for a hand hygiene program? Meinert shared the Hospital’s desire to strengthen what had begun as a humble grassroots effort two years earlier. The anonymous donor from the Fresno business community gave generously to advance the cause of hand hygiene, and became an agent for potentially life-saving change.
The donation paved the way for the Hospital to pursue the hiring of a designated part-time hand hygiene program coordinator, whose job duties will focus solely on our hand hygiene program.

Gel in Gel out dispenserA fast-paced environment presenting regular contact with potential contaminates can make hand washing impractical. But these circumstances do not negate the necessity of hand hygiene. Anyone can pause long enough to simply “Gel-in, Gel-Out.” Hand hygiene champions in each department conduct regular audits to monitor compliance, and crusade for increased awareness of the Hospital’s year-old hand hygiene policy, which calls for cleaning hands before entering and upon exiting any patient room. “We all need to do everything we can to keep our children safe,” said Civiello. She encourages nurses to tell parents, “You are a partner with me in your child’s healthcare.”

Dr. Pugatch takes any opportunity to share the importance of hand hygiene with other doctors. “At meetings I’ll slip it in quietly,” he said. “I say, ‘It’s just part of what we do, like getting the flu shot in flu season.’”
Everyone who comes to Children’s Hospital will soon become familiar with our “Gel-in, Gel-out” phrase. The task force succeeded in placing stanchions of antibacterial gel at all entrances. No one can enter the Hospital without seeing the bold signage promoting the “Gel-in, Gel-out” campaign, or passing a dispenser begging to be squeezed. The bright red signs also announce Purell® containers mounted on walls throughout the hospital.

The goal from the beginning has been to create an atmosphere where people are comfortable pointing out noncompliance. “Don’t be afraid to say, ‘I didn’t see you wash,’” said Civiello. “The correct response, even if you did and they didn’t see, is ‘Thank you for reminding me.’”

“I think our culture shifted in a very positive way toward understanding the feedback is given in the best interest of patient care and patient safety,” said Dr. Pugatch. “And the physicians appreciate and understand that.”

The SAVE LIVES: Clean Your Hands campaign initiated by WHO seeks to move participating countries from merely pledging to actually implementing a hand hygiene policy that results in change at the point of patient care. Children's Hospital has already put feet to our hand hygiene policy by tenaciously promoting our “Gel-in, Gel-out” campaign. Repetition builds awareness, and with knowledge comes the desire to comply. Hand hygiene is the single most important prevention procedure to guard against nosocomial infection, and any statistic below 100 percent compliance puts our patients at greater risk.

The hand hygiene committee invites advocates for clean hands, who are comfortable with speaking up, to join the effort. Unit champions attended classes last January to study the Hospital’s hand hygiene policy, and more vocal supporters are needed. We also celebrate quiet compliance, as demonstrated by the round red “you’ve been spotted” stickers given to recognize employees who practice hand hygiene consistently.

To learn more about how you can be an agent for life-saving change, contact Diane Civiello at (559) 353-5544.


Read about Abby's Generosity and how a gift from a little Fresno girl helped the hand hygiene campaign.