scholarly journals Sustained Improvement in Hand Hygiene Adherence: Utilizing Shared Accountability and Financial Incentives

2013 ◽  
Vol 34 (11) ◽  
pp. 1129-1136 ◽  
Author(s):  
Thomas R. Talbot ◽  
James G. Johnson ◽  
Claudette Fergus ◽  
John Henry Domenico ◽  
William Schaffner ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Financial Incentives ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Project Planning ◽  
Healthcare Personnel ◽  
Sustained Improvement ◽  
Implementation Phase ◽  
The Impact

Objective.To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence.Design.Time-series design with correlation analysis.Setting.Tertiary care academic medical center, including outpatient clinics and procedural areas.Participants.Medical center healthcare personnel.Methods.A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection.Results.A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase (P<.0001) as well as from one phase to the next (P < .0001), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios (R2 = 0.70).Conclusions.Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.

scholarly journals Communications and Screening for 2019 Novel Coronavirus at a Tertiary-Care Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s84-s84
Author(s):  
Lorinda Sheeler ◽  
Mary Kukla ◽  
Oluchi Abosi ◽  
Holly Meacham ◽  
Stephanie Holley ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The United States ◽  
World Health ◽  
Communication Campaign ◽  
Electronic Screening ◽  
Novel Coronavirus ◽  
The Impact

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

scholarly journals Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center

2019 ◽  
Vol 40 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Satish Munigala ◽  
Rebecca Rojek ◽  
Helen Wood ◽  
Melanie L. Yarbrough ◽  
Ronald R. Jackups ◽  
...  
Keyword(s):  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Interrupted Time Series ◽  
Vital Role ◽  
Order Sets ◽  
Urine Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of changes to urine testing orderables in computerized physician order entry (CPOE) system on urine culturing practices.Design:Retrospective before-and-after study.Setting:A 1,250-bed academic tertiary-care referral center.Patients:Hospitalized adults who had ≥1 urine culture performed during their stay.Intervention:The intervention (implemented in April 2017) consisted of notifications to providers, changes to order sets, and inclusion of the new urine culture reflex tests in commonly used order sets. We compared the urine culture rates before the intervention (January 2015 to April 2016) and after the intervention (May 2016 to August 2017), adjusting for temporal trends.Results:During the study period, 18,954 inpatients (median age, 62 years; 68.8% white and 52.3% female) had 24,569 urine cultures ordered. Overall, 6,662 urine cultures (27%) were positive. The urine culturing rate decreased significantly in the postintervention period for any specimen type (38.1 per 1,000 patient days preintervention vs 20.9 per 1,000 patient days postintervention; P < .001), clean catch (30.0 vs 18.7; P < .001) and catheterized urine (7.8 vs 1.9; P < .001). Using an interrupted time series model, urine culture rates decreased for all specimen types (P < .05).Conclusions:Our intervention of changes to order sets and inclusion of the new urine culture reflex tests resulted in a 45% reduction in the urine cultures ordered. CPOE system format plays a vital role in reducing the burden of unnecessary urine cultures and should be implemented in combination with other efforts.

Effect of Female and Male Body Mass index on Cumulative Live Birth Rates in the Freeze-all Strategy

2021 ◽  
Author(s):  
Xi Shen ◽  
Yating Xie ◽  
Di Chen ◽  
Wenya Guo ◽  
Gang Feng ◽  
...  
Keyword(s):  
Live Birth ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Live Birth Rate ◽  
Male Body ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
The Impact ◽  
High Bmi

Abstract Context The impact of parental overweight/obese on cumulative live birth rate in IVF/ICSI using a freeze-all strategy is still unknown. Objective To explore the effect of parental BMI on CLBR in a freeze-all strategy over 1.5 years. Design A retrospective study. Setting Tertiary-care academic medical center Patients or Other Participants 23482 patients (35289 FET cycles) were divided into four groups according to Asian BMI classification. Intervention(s) None. Main Outcome Measure(s) CLBR. Results Female overweight/obesity had the lower tendency in CLBR (groups1-4: optimistic: 69.4%, 67.9%, 62.3%, and 65.7%; conservative: 62.9%, 61.1%, 55.4%, and 57.6%) and the prolonged time (groups 1-4: 11.0, 12.2, 15.9, and 13.8 months for 60% CLBR in optimistic method; 8.7, 9.5, 11.7, 11.0 months for 50% CLBR in conservative method). The same trend with less extent was also observed in male BMI groups. When combining parental BMI, “parental overweight/obesity” had lower CLBR and longer time for reaching CLBR&gt;50% (optimistic: 4.5 months for 60% CLBR; conservative: 3 months for 50% CLBR), the next was “only female high BMI” (optimistic: 2.1 months for 60% CLBR; conservative: 1.7 months for 50% CLBR), while “only male high BMI” couldn’t influence these. Conclusions Our results firstly showed that the priorities of parental BMI, female BMI and male BMI on affecting the 1.5-year CLBR in freeze-all strategy, and the postponed time to reach up the certain CLBR (60% in optimistic, 50% in conservative) for overweight and obese patients was only several months, not so uncertain and long as losing weight.

scholarly journals The Use of Light Sensors in Alcohol Gel Dispensers to Improve Hand Hygiene Compliance of Health Care Workers

2020 ◽  
Vol 41 (S1) ◽  
pp. s411-s411
Author(s):  
Priscila Gonçalves ◽  
Fernando Gatti de Menezes ◽  
Ana Carolina Santiago ◽  
Laura Kataoka ◽  
Paula Fernanda Martineli ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Direct Observation ◽  
Tertiary Care ◽  
Intervention Group ◽  
Healthcare Personnel ◽  
Control Group ◽  
Care Hospital ◽  
The Impact ◽  
Perception Survey ◽  
Intervention Unit

Background: Improving adherence to hand hygiene (HH) of healthcare workers (HCWs) is a challenge for health institutions, and the use of technologies has been considered an important strategy within this process. Methods: To evaluate the impact of the use of alcohol-based hand rub gel (ABHR) dispensers with light sensors on the adherence to HH by HCWs. This is a prospective quasi-experimental study with comparative analysis between two 4-bed adult intensive care units at a private, tertiary-care hospital conducted over 22 weeks. An approach detection module with an LED lamp was attached to the ABHR dispenser. As a healthcare personnel approached it, the sensor was activated, and a red light turned on as a visual stimulus for HH. The color of the light changed to blue when HH was performed. All ABHR dispensers had electronic counters, but light sensors were installed only in the 4-bed dispensers of the intervention unit. Throughout the period, direct observation of adherence to HH was performed by 4 nurses who had previously been rated with an excellent coefficient of agreement (κ test = 0.951 and 0.902). At the end of the study, a perception survey was performed with the HCWs. Results: The median activation of ABHR dispensers per week was higher in the intervention unit with 1,004 (IQR, 706–1,455) versus 432 (IQR, 350–587) in the control group (P < .001). The same occurred when compared to the median activation per 1,000 patient days, with 53,069 (IQR, 47,575–67,275) versus 19,602 (IQR, 15,909–24,500) in the control group (P < .001). However, there was no evidence of difference in adherence to HH during direct observation between the 2 groups: 51.0% HH compliance (359 of 704) in the control group and 53.8% HH compliance (292 of 543) in the intervention group (P = .330). The same result emerged when we evaluated the “My Five Moments for HH” and by professional category. HCWs (N=66) answered the perception survey: 66.6% stated that lighting devices caught their attention regularly or most of the time and 59% agreed that the devices motivated HH. Conclusions: Using light sensors in ABHR dispensers can be an effective technology for improving HH. This finding was evident in the evaluation of the number of uses of the ABHR dispensers and in the HCW perceptions. Although direct observation did not show statistical evidence of difference between the groups, adherence was higher in the intervention group.Funding: NoneDisclosures: None

Use of a comprehensive program to review religious and personal seasonal influenza vaccination exemption requests by healthcare personnel

2020 ◽  
pp. 1-6
Author(s):  
Benjamin C. Boone ◽  
Rochelle T. Johnson ◽  
Lori A. Rolando ◽  
Thomas R. Talbot
Keyword(s):  
Seasonal Influenza ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The Body ◽  
Healthcare Personnel ◽  
Personal Belief ◽  
Job Category ◽  
Appeals Process ◽  
Vaccine Exemption

Abstract Objective: Vanderbilt University Medical Center (VUMC) requires that all faculty and staff receive the seasonal influenza vaccine annually or receive an approved vaccine exemption, either for a medical or deeply held religious or personal belief. We sought to understand the underlying principles behind these exemption requests and their interaction with a multidisciplinary exemption review process. Design: All of the personal and religious exemption requests at VUMC for 3 consecutive influenza seasons from 2015 to 2018 were analyzed, categorizing these requests by 1 of 12 standardized employee categories and 1 of 18 unique reasons for vaccine exemption. Setting: Tertiary-care academic medical center. Participants: Healthcare personnel (HCP). Results: Among the 3 influenza seasons, 1.1%–2.1% of all VUMC HCP requested religious or personal exemption from vaccination. The frequency of religious and personal exemption approval increased annually from 296 of 452 (65.5%) to 196 of 248 (80.2%) to 283 of 323 (87.6%) over the 3 seasons, representing a statistically significant increase each year. Of the 5 most common reasons against vaccination, 4 were explicitly religious in nature; the most common reason was that the “body is a temple or sacred.” Nonclinical staff submitted the most religious and personal exemption requests of any job category, submitting approximately one-third of all requests every year. Conclusions: These results demonstrate how detailed the personal or religious convictions behind vaccine avoidance can be among HCP and how vaccine avoidance stems from much more than simple misinformation regarding vaccination. The intersection between misinformation and personal or religious beliefs provides a unique opportunity to address HCP opinions toward vaccination in an exemption and appeals process like the one described here.

scholarly journals How Standard Are Standard Precautions? Knowledge and Attitudes Toward Standard Precautions at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s254-s254
Author(s):  
Rebecca Faller ◽  
Priya Sampathkumar ◽  
Stacy (Tram) Ung
Keyword(s):  
Hand Hygiene ◽  
Waste Disposal ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Healthcare Setting ◽  
Healthcare Personnel ◽  
Standard Precautions ◽  
Respiratory Therapists ◽  
Inpatient Settings

Background: Standard precautions are the basis of infection prevention and include a set of common-sense infection control practices that prevent transmission of diseases acquired by contact with blood, body fluids, nonintact skin, and mucous membranes. These measures include hand hygiene, personal protective equipment (PPE), cleaning and disinfecting, linen handling, waste disposal, sharps safety and respiratory etiquette. Standard precautions require that the risk for exposure be assessed and appropriate precautions taken based on risk. Observations and anecdotal evidence have led us to believe that understanding of standard precautions is lacking among healthcare personnel. Methods: A survey was conducted at a large health system to assess knowledge and practices related to specific elements of standard precautions. Results: More than 3,000 HCWs responded from inpatient settings (41%), outpatient settings (37%), and both settings (22%). Nurses comprised the majority of respondents (54%), and others included physicians (9%), respiratory therapists, as well as physical and occupational therapists. Discussion: The vast majority (96%) of respondents agreed that standard precautions were required in the care of all patients, but a significant proportion (34%) interpreted that to mean that standard precautions always involve wearing gloves, and 22.5% thought that PPE was always required for standard precautions. Hand hygiene and sharps safety were identified as the best understood elements of standard precautions. Respiratory etiquette and cleaning and disinfection were reported as the least understood elements, with PPE, waste disposal, and linen handling also being reported as inadequately understood components of standard precautions (Fig. 1). Conclusions: In an era of increasing drug resistance and fewer effective antibiotics, standard precautions are our best defense against the spread of infections in the healthcare setting. Our survey showed that there is room for improvement among healthcare workers in understanding of the elements of standard precautions. We plan to use the survey to craft a targeted education campaign to improve understanding of and adherence to standard precautions.Funding: NoneDisclosures: None

Expanding mandatory healthcare personnel immunization beyond influenza: Impact of a broad immunization program with enhanced accountability

2020 ◽  
pp. 1-6
Author(s):  
Thomas R. Talbot ◽  
Ruth Schimmel ◽  
Melanie D. Swift ◽  
Lori A. Rolando ◽  
Rochelle T. Johnson ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Immunization Coverage ◽  
Healthcare Personnel ◽  
Varicella Vaccination ◽  
Hepatitis B Vaccination ◽  
Immunization Program ◽  
Data Feedback ◽  
Before And After

Abstract Objective: Evaluation of a mandatory immunization program to increase and sustain high immunization coverage for healthcare personnel (HCP). Design: Descriptive study with before-and-after analysis. Setting: Tertiary-care academic medical center. Participants: Medical center HCP. Methods: A comprehensive mandatory immunization initiative was implemented in 2 phases, starting in July 2014. Key facets of the initiative included a formalized exemption review process, incorporation into institutional quality goals, data feedback, and accountability to support compliance. Results: Both immunization and overall compliance rates with targeted immunizations increased significantly in the years after the implementation period. The influenza immunization rate increased from 80% the year prior to the initiative to >97% for the 3 subsequent influenza seasons (P < .0001). Mumps, measles and varicella vaccination compliance increased from 94% in January 2014 to >99% by January 2017, rubella vaccination compliance increased from 93% to 99.5%, and hepatitis B vaccination compliance from 95% to 99% (P < .0001 for all comparisons). An associated positive effect on TB testing compliance, which was not included in the mandatory program, was also noted; it increased from 76% to 92% over the same period (P < .0001). Conclusions: Thoughtful, step-wise implementation of a mandatory immunization program linked to professional accountability can be successful in increasing immunization rates as well as overall compliance with policy requirements to cover all recommended HCP immunizations.

scholarly journals Socioeconomic Determinants of Tertiary Rhinology Care Utilization

OTO Open ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 2473974X2110098
Author(s):  
David M. Poetker ◽  
David R. Friedland ◽  
Jazzmyne A. Adams ◽  
Ling Tong ◽  
Kristen Osinski ◽  
...  
Keyword(s):  
Medical Center ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Education Level ◽  
Care Utilization ◽  
Median Income ◽  
Academic Medical ◽  
Electronic Health ◽  
The Impact

Objective The objective of this study was to determine the impact of patient demographics and socioeconomic factors on the utilization of tertiary rhinology care services in an upper Midwestern academic medical center. Study Design Retrospective review of electronic health records. Setting Academic medical center. Methods The electronic health record of our academic center was interrogated for the demographics and diagnosis of chronic rhinosinusitis (CRS) among adult patients seen by fellowship-trained rhinologists from 2000 to 2019. Patient characteristics (age, sex, race, insurance status) and population-level data (median income and education level) were compared with utilization of tertiary rhinology services for CRS. Utilization rates were calculated for each regional zip code and correlated with census data for median income and education. The association between determinants of health and tertiary rhinology utilization was assessed by multivariate regression analyses. Results A total of 8325 patients diagnosed with CRS used tertiary rhinology services. Patients were older (median, 58.9 years) and more likely to be female (57.6%), White (85%), and privately insured (60%) when compared with patients seen across our hospital system ( P < .001). Adjusted analyses showed median income, education level, and White race to be independently correlated with tertiary care utilization. Private insurance alone was not an independent contributing factor to access. Conclusion Utilization of tertiary rhinology services correlated with income, race, and education level. Private insurance was not an independent factor. These results highlight social differences in determinants of access to tertiary otolaryngologic care.

scholarly journals 1195. Hand Hygiene Compliance of Patients’ Family Members in India: Importance of Educating the Unofficial “Fourth Category” of Healthcare Personnel

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S429-S429
Author(s):  
Manisha Biswal ◽  
Archana Angrup ◽  
Surria Rajpoot ◽  
Rupinder Kaur ◽  
Kulbeer Kaur ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Tertiary Care ◽  
Family Members ◽  
Hospital Setting ◽  
Healthcare Personnel ◽  
Care Hospital ◽  
Awareness Campaigns ◽  
Hygiene Compliance ◽  
The Impact

Abstract Background In India,due to manpower constraints, patients’ family members are often actively involved in healthcare activities of their near and dear ones. They have significant contact with the patient at all the 5 moments for hand hygiene (HH) as listed by WHO. At our tertiary care hospital in north India, we have been monitoring HH compliance (HHC) for nearly a decade. In this study, we analyzed the impact of decade long awareness campaigns to improve HH compliance in our patients’ attendants. Methods Trained infection control nurses directly observed the compliance to hand hygiene at each of the five moments for patients’ attendants over different areas of the hospital over a period of 5 years (January 2014–December 2018). Compliance was calculated as percentage of events over total opportunities and compared. Results 7290 opportunities were observed with an overall compliance of 46.3%. The overall HHC in patient attendants has increased from 35.5% in 2014 to 48.2% in 2018 (P < 0.0001). Compliance at WHO moment 1, 2, 3, 4 and 5 was 51.2%, 47.8%, 67.8%, 48.9% and 24.4% respectively. Among family members, mothers of newborn babies had a much higher HHC (77%) than others (44.7%) (P < 0.0001). Also, the compliance was higher in medical vs. surgical wards and pediatric wards vs. adult wards (P < 0.0001 in both). Conclusion This is the first study about family members’ HHC in a hospital setting in a low and middle-income country. Once trained, family members exhibit fairly good hand hygiene compliance while involved in healthcare activities of their patients. Mothers of newborn babies exhibit exemplary hand hygiene compliance while caring for their babies in our hospital. It is worthwhile empowering and educating patient attendants about the importance and process of hand hygiene as it is likely to result in immense benefit for patients. Disclosures All authors: No reported disclosures.

A 10-year analysis of "revenues," costs, staffing, and workload in an academic medical center clinical chemistry laboratory

1993 ◽  
Vol 39 (9) ◽  
pp. 1780-1787 ◽  
Author(s):  
H Benge ◽  
G Csako ◽  
F F Parl
Keyword(s):  
Direct Cost ◽  
Clinical Chemistry ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Chemistry Laboratory ◽  
Full Time ◽  
Relative Contribution ◽  
Clinical Chemistry Laboratory ◽  
The Impact

Abstract From 1980 to 1990 we found progressive increases in workload (number of billable tests; 12.1% per year), staffing [number of full-time equivalents (FTEs); 5.6% per year], "revenues" (gross billings; 25.8% per year), and direct cost (12.9% per year) in the clinical chemistry laboratory of a large tertiary-care university medical center. The increase in direct cost was mainly attributable to an increase in salary cost (23.7% per year), whereas the impact of increasing "consumable" cost was relatively small (5.3% per year). In fact, after adjustment for inflation, the consumable cost was virtually unchanged or decreased during the 10-year study period. Initially, consumables represented about 60% of the direct cost, and the remaining 40% was for salaries. After 1982/83, however, the relative contribution of consumables and salaries to direct cost gradually reversed. Because the workload grew at a higher rate than staffing, the workload per FTE increased from 1980 to 1990. This was paralleled by gradual increases in both "revenue" per FTE and salary per FTE in actual dollars, but by lesser increases to no increases in inflation-corrected dollars. After adjusting for inflation with different indices, the direct cost per test, the consumable cost per test, and the salary cost per test either remained unchanged or decreased in the 1980s. The findings are discussed in the context of technical advancements in laboratory testing, nationwide shortages of medical technologists, and implementation of prospective fixed-fee reimbursement practices during the study period.

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