Pip Brown (centre front) and the Haematology Day Stay team have
overhauled their approach to hand hygiene.

Auckland District Health Board
Ward of the quarter, March 2013

A lower than anticipated hand hygiene compliance rate sparked the haematology day stay team at Auckland District Health Board (ADHB) into action; resulting in big changes to their patient environment and a complete overhaul in their approach to hand hygiene.

“It was our first local hand hygiene audit, and it was a real eye opener,” says Pip Brown, Haematology Nurse Educator at ADHB.

“We realised that the layout of our day stay environment was impacting upon our hand hygiene practice and on improving infection prevention as a whole.”

Keen to make changes as quickly as possible, Pip and the team spent a morning with ADHB’s hand hygiene coordinator, Louise Dawson, to identify environmental barriers to good hand hygiene and how they could be overcome.

The ward, which has capacity for 22 patients, either in lazy boy chairs or patient beds, has limited physical space. For the day stay team, defining the patient zone (the dedicated space for the patient’s stay while in a healthcare facility) in the three communal spaces that house 10 lazy boy chairs was difficult.

“Patients were sitting really close together and we were all sharing tables. Patients would put their items on the table and we would put our equipment on them too because there was no room for extra tables,” says Pip.

“If a patient’s machine started beeping, whoever was closest would just reach across the patient zones and attend to it, then go back to their patient. We also had one central area where we kept all our equipment and hand gel, which meant we were constantly criss-crossing around and between rooms to get to it.

“In the patient rooms we had glove dispensers outside of the curtains. This meant that if we put on gloves and opened the curtains we would contaminate the gloves,” adds Pip.

After standing back and witnessing what Pip calls “the terrible mess”, the team set about making changes.

Nurses are now allocated specific patient areas to attend to and each room has its own equipment zone. This reduces the amount of cross-traffic between patients and to get supplies, as well as potential cross contamination.

To avoid contamination from touching the curtain, the team is improving their approach to glove use and reducing contamination by fixing glove dispensers inside the patient zone.

“We also no longer share tables with patients. Each patient has their own table and we have purchased special equipment trolleys that wheel over the top of the patient table to keep our procedure equipment separate and clean,” says Pip.

“This means we can put all our equipment and hand gel onto the trolley, and the trolley stays in the patient zone permanently.

This way there is less contamination with trolleys moving between patients and we are not touching their surroundings or belongings as often,” she adds.

Posters promoting the five moments for hand hygiene now adorn the walls in each patient area, as well as above sinks. A big board featuring hand hygiene information also encourages patients that to ask staff about hand hygiene.

“These changes have made a really big difference to our practice, both from a hand hygiene perspective and an overall infection control perspective. Most importantly we are improving the care we provide to our patients,” says Pip.

After the changes were made a second local audit showed that hand hygiene compliance had vastly improved to 76 per cent.

“The whole team is really proud. We have a much more patient safety oriented space and everyone is very keen to keep it up!” Says Pip.