HHNZ quality improvement workshop 2014: Shelley Frost speech

Tena koutou katoa, welcome to participants who have come together from across New Zealand to share their experiences of improving hand hygiene practice and to learn new ways of motivating and engaging their colleagues to take the lead in ongoing improvements in practice.

As Deputy-Chair of the Health Quality & Safety Commission’s Board, and a registered nurse, it is my pleasure and privilege to be here with you all this morning to open this national hand hygiene quality improvement workshop.

The next two days will bring together hand hygiene champions from across the country to focus on and explore quality improvement activities that will build on the substantial improvements that have been achieved over the past three years.

This event will provide the impetus to keep moving forward. It will also join you in a common purpose: continuous improvements in hand hygiene to reduce the harm to patients and consumers from healthcare associated infections.

As you will be aware, the hand hygiene programme is one of three initiatives that have been developed within the Commission’s infection prevention and control programme.

The Health Quality & Safety Commission was established in 2010 to ensure all New Zealanders receive the best health and disability care within available resources.

Every day, New Zealanders receive safe and high quality care from health and disability service providers. However, unfortunately, some patients and health consumers acquire healthcare associated infections while receiving health care in hospital as in-patient or out-patients, in community-based health facilities and in their own homes.

Good hand hygiene practice is fundamental to safe patient care. It is the most simple and cost-effective way of preventing healthcare associated infections and is also crucial to halting the spread of multiresistant organisms in healthcare settings.

Hand Hygiene NZ has provided the energy, commitment and drive to re-invigorate the national hand hygiene programme in DHB hospitals over the past three years.

With your determined efforts and collaboration, there has been a steady improvement in hand hygiene performance around the country. All 20 DHBs first submitted performance data in October 2012. At this time the national performance rate was 61.2 percent. In the most recent audit in March 2014, this had risen to 72.6 percent. Further improvement is expected in the current performance audit. The aspirational goal for all healthcare worker groups in June 2014 is 75 percent, and 80 percent in June 2015.

Not so long ago this level of improvement might have appeared unattainable but the sustained work you have been undertaking in your own work places has led to the growing awareness among all healthcare professionals that good hand hygiene is inseparable from safe clinical care.

The results of the most recent hand hygiene audit in March show that nurses and midwives continue to show strong improvements in practice at the frontline of care. They, and the phlebotomists, who need special mention for consistently high performance, are excellent role models. I note however that doctors are still lagging behind despite being widely regarded as leaders in the healthcare setting.

The challenge for those doctors present today is to encourage ownership of this issue by your colleagues. The challenge for others is to engage doctors, and especially senior doctors, based on the findings of the latest attitudinal survey from HHNZ, to provide leadership to the next generation of house officers and registrars coming through.

In this survey 60 percent of doctors said that their senior colleagues influenced their hand hygiene practice, while only half of the 65 doctor respondents considered patients to be an influence on their day-to-day practice.

These results are striking when you consider 99 percent of respondents agreed there was a strong evidence base and clinical rationale for hand hygiene.

Walking the talk, showing patients, families/whanau and your co-workers that good hand hygiene is a vital step before and after every patient contact, before and after every procedure and after contact with the patient’s surroundings is not only clinically sound, it’s simple, and it’s effective.

The Commission regards hand hygiene as an essential component to its infection prevention initiatives. As you know, hand hygiene is the first step of the CLAB insertion checklist. Hand hygiene is also central to surgical asepsis and the care of patients throughout their surgical journey.

Improvement programmes require a clear aim. They focus the work we are engaged in and identify what needs to be measured to show that the aims are being met.

The aim of the hand hygiene programme is to reduce healthcare associated infections through adherence to the 5 moments for hand hygiene for every patient every time.

The Quality & Safety Markers are one way of measuring the progress and improvements you are making to patient safety and quality of care. The goals set by the Commission for the national hand hygiene programme are time-specific and measurable and create an expectation that change is achievable.

I am aware that improving hand hygiene practice is no small task – it involves culture change across organisations, among all healthcare workers groups. Hand hygiene is an integral part of every patient interaction, in every healthcare setting. This is a challenging undertaking for which you need to be equipped well. Developing capability in improvement in the health sector is also a key priority for the Commission.

Over the next two days the sessions offered during this workshop will reinforce the improvement strategies developed by the WHO 5 moments for hand hygiene. They will also provide you with an additional set of quality improvement interventions, tools and resources based on the Frontline Ownership model.

These tools and interventions are designed to increase the speed of improvement, embed change, and engage healthcare workers and others – don’t forget your cleaners and other auxiliary workers who contribute to safe patient outcomes – in the shared goal of reducing the harm of healthcare associated infections.

Patients assume that hand hygiene will be of the highest standard when they enter our hospitals. They do not anticipate they might have to prompt healthcare workers in what is an essential clinical competency. Further change is needed to ensure patients and their families/whanau consistently receive the safe care they expect at every step of their healthcare experience.

I would like to congratulate you all on the Commission’s behalf on the outstanding results you have achieved so far. I would encourage you to make the most of this tremendous opportunity to share and learn, and to go back to your own organisations refreshed with new skills and tools and renewed enthusiasm to tackle the goal of best practice for every patient, every time.