FLU-Give it a Shot!

flu-shot-photoOctober is a busy month for health professionals. We celebrate Breast Cancer Awareness Month, Mental Health Awareness Week, Dental Hygiene Month, Chiropractic Health Month, Pharmacist Month, Domestic Violence Awareness Month, Health Literacy Month and Patient Centered Care Awareness Month.

There are more awareness areas to be celebrated.  However, one is missing from the list.  It is special to October as it is the month that flu season begins and we all should be planning flu clinics and getting our own flu vaccines.

Recently the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization and Practices (ACIP) adopted recommendations for the 2016-2017 flu season. This year two changes are noteworthy. The first is that the live, attenuated influenza vaccine (LAIV) has been found to be ineffective and will be unavailable this year. The second is that they have eliminated the egg allergy limitations of the past.

2016-2017 Changes

  • Flu Mist is Out-With no significant effectiveness found with the live virus vaccine, this year children’s immunization recommendations are for intermuscular doses only. Basically, children under 9 years of age will require one injection, children 6months to 8 years old will require two doses of the vaccine, unless they have received intermuscular injections in the past. Everyone 9 years of age and older, require only one dose of the 2016-2017 flu vaccine.
  • Egg Allergy Recommendations-These recommendations have changed a lot from prior years and the ACIP has listed the changes on their website. In summary, patients should still be observed for 15 minutes after the vaccine just in case there is a reaction. If a person has a history of a severe allergy to eggs, a medical provider should monitor their vaccinations. 

Nurses Responsibilities in Herd Immunity: Since corrections health is community health in many ways, nurses have a very important role during flu season and that begins with getting vaccinated. In the world of patient safety, a term called “Herd Immunity” is referred to as a means of stopping the spread of diseases. It also be called community immunity and describes protection from a contagious disease with community wide vaccination. The goal is prevention and containment of the disease. The concept is for the chain of infection to be interrupted by those vaccinated thus stopping the spread of disease to a susceptible host.

18 States have Mandates: In taking a leadership role in disease prevention, 18 states no longer allow health professionals to make a personal choice in obtaining an influenza vaccine. These laws are based on the hospital or facility type at this time. Since corrections facilities have a very fragile and vulnerable population, the same mandate should apply to personnel who work in these facilities as well.  Use this link to research the vaccination laws being published by the CDC.

Prevention is the Key: As nurses, we incorporate prevention into all our patient care activities and treatments. Key prevention tips include:

  • Wash your hands frequently and effectively.
  • Avoid close contact with those who show signs and symptoms of illness.
  • Stay home from work when you are sick.
  • Cover your mouth and nose when coughing or sneezing.
  • Avoid touching your eyes, nose or mouth.
  • Practice good health habits to stay healthy yourself.
  • Obtain flu vaccines for yourself and your family.

Outbreaks: In our corrections facilities, we do not have the luxury of isolating people in their homes or controlling their activities. However, there are processes we can plan for before an outbreak occurs or put in place if an outbreak occurs in your facility.

  • Educate the population about flu season and what they can do to reduce their risk.
  • Work with the local health department or pharmacist for a supply of flu vaccine. The supply this year is supposed to be adequate.
  • Monitor for outbreaks and track them. Work with custody to group ill inmates together, reduce movement, and limit visiting and other things to reduce transmission.
  • If ill patients have to go to court, institute droplet precautions by issuing a mask. Use a gown and gloves if necessary. Sometimes I have seen video court used with ill inmates or court delayed.
  • Administer antiviral treatment for those most vulnerable such as the elderly, chronically ill, immune compromised, pregnant or have acute medical conditions.
  • Consider vaccines for the entire population. Whether a jail or prison, every flu vaccine you administer, reduces the spread of disease in the community when they are released or have visitors.
  • Remember custody in your vaccination program. They want to stay healthy and not spread disease just like health staff.

Remember that vaccination is a community effort. Nurses’ commitment to vaccination best practices is critical to staying healthy and saving patient lives this influenza season. GIVE IT A SHOT

What is the influenza immunization policy in your institution? What practices are part of your plan to reduce the spread of disease? What happens when your facility has a flu outbreak? We enjoy hearing about your experience so please reply in the comment section.

Read more about the identification and management of infectious diseases in the correctional setting in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today! 

Photo Credit: http://www.U.S.fotolia.com/ https://www.fotolia.com/id/120105499

Stewardship involves the health care team

The last two posts have been about the challenge we all face in preventing the development of antibiotic resistance and treating those who have antibiotic resistant diseases. In today’s world of antibiotic resistant diseases, we all are guided to be vigilant when the plan of care contains antibiotic therapy. Providers have an important role in antibiotic stewardship and so does the rest of the corrections health team, including the nursing staff, the pharmacy, laboratory and clerical staff to ensure our patients receive the community standard of care with regard to treating infectious disease. This post highlights the U.S. Department of Justice, Bureau of Prisons’ development of guidelines for antibiotic stewardship in correctional health care.

Clinical practice guidelines

In 2013, the Bureau of Prisons (BOP) published Antimicrobial Stewardship Guidance. The BOP is the first correctional health care system to develop and make available to the public a written plan to address prevention and treatment of antibiotic resistant disease. Since then other systems have used it as the basis to develop their own guidelines on the use of antibiotics.  The BOP guidelines provide information about:

  • diagnosing and identifying infections
  • understanding lab values,
  • therapy selections,
  • multi-drug resistant organisms
  • national guidelines for treatment.
  • to communication, competencies and training.

Strategies of the BOP Program

The BOP guidance is based upon four strategies:

  • Education for all staff about appropriate use of antimicrobial agents
  • Formulary management with varying degrees of restriction in the use of antibiotics
  • Prior approval programs for antibiotic medications not on the formulary
  • Converting patients from broad to narrow spectrum antibiotic therapy.

Communication, communication, communication

Communication, is at the heart of success in promoting antibiotic stewardship.  The BOP guidelines stress that patient satisfaction is influenced more by communication, than by whether or not the patient receives an antibiotic. Communication is used to validate the patient’s illness, help them understand the disease as well as the treatment options. Sometimes antibiotics are warranted and sometime they are not and we use communication to help the patient understand the treatment recommended for their illness.  Communication practices recommended by the BOP include:

  • Choosing terminology–using the diagnosis name instead of referring an illness as “just a virus” validates the patient’s symptoms. They will be more willing to participate in the treatment plan when they know you care about what is happening to them. No matter how mild or severe, all illnesses are important to the patient.
  • Offering symptomatic relief—it takes sensitivity when talking about a condition that is a virus or other illness that does not require use of antibiotics. Provide information about symptomatic relief such as over the counter medications, showers, hydration, gargles and warm or cold packs. In addition to talking with the patient provide a handout to reinforce the information.
  • Discuss expectations for the course of illness and possible medication side effects—none of us hears everything the provider tells us at a visit. Our patients benefit from knowing what to report, what improvements looks like and when to report worsening symptoms. Patients should receive information about their illness, treatment or self-care options, what to expect and when to seek medical attention from nursing staff and others at every subsequent patient interaction.

Good communication provides the means to engage patients in the recommended and most appropriate treatment regime.

Nursing competencies and training

Infectious disease is a large group of illness and a challenge in maintaining a current knowledge base. In corrections health, we become more proficient in the most common diseases that our patients have. To assist us we have tools, such as standard protocols for MRSA and skin infections, pneumonia, tuberculosis, sepsis, gynecological infections, urinary infections and sexual transmitted diseases. Just keeping up with the laboratory tests and newly developed antibiotics can be a daily learning experience.

The BOP guidelines list the following infectious disease competencies for correctional nurses:

  • Understanding culture and sensitivity laboratory report results.
  • Understanding common IV antibiotic dosing, frequencies and regimes.
  • Knowing the signs of improving clinical status that facilitate de-escalation.
  • Understanding the timing of medication dosing and blood sample collection.
  • Knowing the signs/symptoms of common allergic reactions to frequently used medications.
  • Awareness of the facility antibiotic therapy guidelines.
  • Knowing the common side effects and adverse events associated with antimicrobials.
  • Understanding the principles of antibiotic stewardship.

The ups and downs of antibiotics

In 1928, Sir Alexander Fleming, discovered a naturally occurring antiseptic enzyme. He was quoted as saying “one sometimes finds what one is not looking for”. From his work, in six years, penicillin was discovered.  From early to modern history antibiotics have played a major part in wellness and prevention of mortality.  Today, we have new challenges from organisms adapting to medications and not curing illness. Everyone in the health care profession is working to curb this and to ensure all of us receive treatment that HEALS.

Are the infectious disease competencies for correctional nurses recommended by the BOP the ones you would recommend? What additions or changes to this list of competencies would you recommend? Please share your ideas by replying in the comments section of this post.

Read more about the identification and management of infectious diseases in the correctional setting in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today! 

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Antibiotic Stewardship has Four Rights

stewardship photo

The subject of antibiotic stewardship was touched upon in last week’s post about Superbugs. The goal of these programs is to avoid unnecessary and inappropriate use of antibiotics to prevent development of antibiotic resistant disease organisms. In addition to curing illness, appropriate antibiotic use should also reduce side effects of medications and lower health care costs.

Inpatient settings, such as hospitals and long term care, have had programs in place to monitor the use of antibiotics for some time. In 2009, the Centers for Disease Control and Prevention (CDC), launched the “Get Smart for Health Care Campaign  ” to promote the improved use of antibiotics.  The Joint Commission and the Infectious Disease Society of America (IDSA) have also come out with recommendations, guidelines and tool kits for health care settings to begin their own stewardship programs.

Correctional facilities are also patient care settings

A study by the CDC indicates that 30-50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. How does that translate to corrections health? The article states that overprescribing and mis-prescribing is contributing to the development of antibiotic resistant bacteria and challenges from side effects of antibiotic use. Of all the health care settings, corrections health is probably the most cautious in prescribing medications for patients because our patients come from an “medication dependent culture”, whether legal or illegal.  Many corrections health programs have policies, procedures and clinical protocol to guide the assessment, diagnosis and treatment of the most common antibiotic resistant conditions, such as methicillin resistant staph aureus (MRSA), resistant tuberculosis and gonorrhea. Even with these practices in place, are correctional health care programs able to assert that all antibiotic use is appropriate? Probably not.

The fundamental four rights

The goal of antibiotic stewardship has four points to ensure that patients being treated for infectious conditions receive:

  • the right antibiotic
  • at the right dose
  • at the right time and
  • for the right duration

Most correctional health programs already have in place the components of an antibiotic monitoring system. The existing quality improvement (CQI) program or pharmacy and therapeutics (P & T) committee should include monitoring of appropriate antibiotic use among the subjects reviewed. Staff to lead the effort could include the staff or consulting pharmacist, the medical director or other provider, infectious disease specialist or nurse, or one of the staff responsible for medication administration. By using existing resources and interest, it is possible to initiate antibiotic stewardship at your facility, no matter how large or how small.

Common guidelines to ensure antibiotic stewardship

Practical advice for implementation of antibiotic stewardship include these recommendations from the Infectious Disease Society of America, which can be translated into any setting:

  • Pre-authorization or review of orders for targeted antibiotics with consultation provided about alternatives.
  • If pre-authorization or consultation is not available, after two or three days of treatment review the patient’s response to treatment and adjust treatment accordingly.
  • Conduct a continuous quality improvement study or audit of patient response to treatment with antibiotics to identify areas to target for improvement.
  • Timely diagnostic services, especially for respiratory specimens, aids in the determination of whether antibiotics are necessary.
  • Use of standard protocols for specific diagnoses or syndromes to guide the assessment, treatment and evaluation of the patient’s response to treatment.

Corrections health reflects the community.

Correctional health care is consistent with and supportive of health care in the community. With statistics like 23,000 deaths per year in the US from antibiotic resistance, stewardship and oversight of antibiotic use has become the community norm.  The safety of our patients and in essence the community, requires that we attend to the appropriate use of antibiotics in the correctional health care setting as well.

If your facility has an antibiotic oversight or stewardship program, please share your experience with us by replying in the comment section of this article.  Next week will examine the Bureau of Prisons’ antibiotics stewardship program and the role of nursing!


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Superbugs are not only in your garden!

superbugsDo you find bugs in your yard and garden that are eating your plants, roots, grass and eliminating flowers? Have you tried pesticides only to find the bugs come back stronger by becoming pesticide resistant? Our bodies are the same as plant life in the garden.  The ready availability and use of antibiotics to treat illnesses has resulted in emerging infectious diseases that are resistant to known treatment modalities.

News is Full of Superbug Warning

There are more and more articles in the community papers, TV news shows and health care literature about the challenges to cure health conditions that are caused by medication resistant organisms. The most recent story  warned that in the US this new “nightmare superbug” is a strain of e-coli.  They used the words “alarming development and terrifying”.  Other frequently discussed antibiotic resistant infections have been for tuberculosis, gonorrhea, and skin infections. Some parts of the world are trying to get a handle on resistant strains of malaria.

Corrections Health Responses

In recent years, corrections health programs have developed guidelines and procedures for skin infections and tuberculosis.  They vary with the program and include prevention, identification, treatment and follow up care.  The level of isolation or protection and the use of an antibiotic regime is set by the medical directors and pharmacists.  Custody and health staff have become accustomed to being taught about preventing contagious disease and are skilled in using standard precautions, wearing gloves, respecting wounds that are bandaged and reporting concerns to medical.  Having sanitizing gel and gloves available around the facilities is the norm now instead of the exception.

Precautions to Consider

The picture of superbugs really encompasses a world view as changes in how we live and the treatments we receive for illness has contributed to more organisms being resistant to current therapies.  We normally focus on our facilities, however, some of the recommendations to help slow down the emerging resistant diseases encourages us to take a larger world view of public health. The United Kingdom recently published a multi-nation review of how to tackle the problem of drug resistant organisms infections. The report outlines steps that should be taken by each of us individually and as leaders in health care at our facility to curb the tide of emerging “superbugs”.

  • Raise awareness of the threat of inappropriate antibiotic use.
  • Improved hygiene to safeguard against infections.
  • Less unnecessary microbial use in agriculture, aided by improved transparency by retailers and food producers.
  • Better monitoring of drug resistance.
  • Development of both diagnostics to cut unnecessary antibiotic use and improved vaccines and alternatives.

Another recent article about superbugs described a woman in Pennsylvania diagnosed with drug resistant e-coli and noted the specialized diagnostic and therapeutic resources necessary to treat her. The article also described how new the information about emerging drug resistant disease is and the lack of coordinated and widely disseminated research.  So not only do we all need to keep abreast of the infectious disease that are arriving in our facilities, but bring awareness of the need for specialized education and training in infectious disease prevention.

Main Warning

We have heard for years about the dangers of antibiotic resistant diseases and have developed procedures and protocols in monitoring and treatment. The most frequently stated practice change is to have antibiotic stewardship programs to curb the inappropriate use of antibiotics. Many of our patients coming into custody have a history of frequent antibiotic use and want us to give them antibiotics for many of their ailments. We need to provide patients with education about appropriate antibiotic use; we also need to ensure staff are knowledgeable and that the practice guidelines are based upon the most current evidence.  To address resistance in gardening we now treat superbugs with beneficial insects like green lacewings, ladybugs and praying mantis so lets do the same in health care with appropriate antibiotic use and stewardship. That way we may affect the predictions that millions of people may become ill from “superbug infections” by year 2050.

What are you doing to help curb antibiotic use in your place of work? Do you have any special patient teaching tips or resources you would like to share with us? If you do please put your sharing in the comment sections below.  We all can learn from each other.


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Ebola: Another Look at Infection Control

EbolaA colleague of mine from Dallas, Texas mentioned on a phone call last week how busy things were in the health care industry with the death of Mr. Duncan from Ebola. Now that Nina Pham, a nurse who cared for him has Ebola, I imagine things have heated up even more. Another nurse in Spain has been infected as well after caring for a patient with Ebola. I’ve also seen one report of a jail in Wisconsin that has a detainee under medical surveillance for Ebola symptoms because she recently arrived from West Africa.

People worry about infectious diseases especially when it is a new and threatening disease, even when the risk of infection seems remote. Nurses are a trusted resource and often the first person staff and inmates seek information from about an infectious disease and what can be done to protect themselves. The next several months will be an opportunity for correctional nurses to shine in providing accurate information and advice about Ebola and infection control more generally.

Health teaching and promotion is one of the American Nurses Association (ANA) practice standards for correctional nurses (2013). The competencies for health teaching and promotion include:

  • Addressing a variety of topics that reduce risk and promote health.
  • Using teaching methods appropriate to the situation and the audience.
  • Seeking feedback and evaluation of the effectiveness of teaching strategies used.
  • Using information technologies to communicate information.

Here are five tips to use in providing health information about Ebola for staff and inmates at your correctional facility.

  1. Give credible information. The Centers for Disease Control (CDC) is going to be your best resource. Here is the link to the CDC web page which includes the latest news and advice for hospitals as well as community settings. Another resource is the local health department for your area. It is not uncommon for people to bring forward concerns or information that is contrary to your information or advice. The best approach here is just to cite your sources and ask that those with opposing information cite theirs so that individuals can make up their own minds after considering the information they have received.
  2. Give concrete suggestions about what to do. People often feel helpless and vulnerable in the face of a disease that they know little about. Suggesting concrete steps that can be taken goes a long way toward reducing the fear and anxiety associated with an unknown risk. You might suggest, for example, looking up one of your references or giving people a resource site to go to. Another suggestion might be for someone to assess their knowledge and skill in hand hygiene or use of personal protective equipment.
  3. Reinforce the information already known about infection control. Ebola is spread by direct contact with infected body fluids. We know that prevention measures are to use standard, contact and droplet precautions when caring for someone with an infectious disease transmitted by direct contact. Emphasize the measures that are already in place at your facility to protect staff and other inmates from transmission by direct contact.
  4. Link new information to past efforts and successes. The concern and anxiety about a new infectious disease can be reduced if staff and inmates can see a link to other successes with infection control practices in everyday life.
  5. Look for allies to help spread the word. If you can demystify the disease, people will feel less victimized by the unknown and uncontrollable and ready to take the steps they need to in protecting themselves. When non-medical personnel at a correctional facility embrace the facts about Ebola and the steps to prevent transmission you have mastered control of the infection. Often getting an organization to this place is jump started when a member of the custody staff becomes a spokesperson about the disease. Invest time in sharing information with interested custody staff and they will help carry the message. The same is true for inmates; often peer educators are more effective than professionals in getting important health information across to others.

Two more thoughts about how as correctional nurses we can prepare for the Ebola virus:

  • Even if the possibility of the disease presenting at your facility may seem remote ask what can be learned from it about the infection control practices you have in place. For example, the nurse in Dallas is hypothesized by CDC to have become infected as a result of a breach in infection control practices. We all know how routine infection control practices are part of the daily routine so ask yourself if there are breakdowns you may not be aware of? It is a good time to audit infection control procedures to ensure that identification and prevention measures are up to date and intact.
  • Keep up with information about the disease and what is recommended in relation to infection control. Our hearts go out to the nurse, Nina Pham; and we want to learn everything we can from her experience so we can protect ourselves. The CDC is investigating the infection control practices she used and it will be important for every nurse to incorporate what we learn into our own practice.

The CDC is sponsoring a teleconference for health care professionals on preparing for Ebola October 14 and the ANA has a resource page about Ebola for nurses. What advice do you have for correctional nurses about how to respond to questions about Ebola virus? Please share your advice by responding in the comments section of this post.

For more on standard, contact and droplet precautions see Chapter 10 Infectious Diseases written by Sue Smith in the Essentials for Correctional Nursing. She also discusses the role of correctional nurses in providing information and education about infectious disease. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

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Best Practices to Promote Hand Hygiene

Word cloud for Hand washing“Hand hygiene seems so simple but is complex in health professionals minds otherwise it would be done all the time. Having hand washing ‘handy or in close proximity’ to the work seems to be one key. We need dispensers on all medication and treatment carts as well as all other trays or patient care areas. Then the real effects of hand washing and hygiene can be felt with reduced illness and infection among patients as well as care givers” commented Gayle Burrows, an experienced correctional nurse administrator, on the previous post. Her observation echoes recommendations from the Institute for Healthcare Improvement that hand hygiene of healthcare workers improves greatly when the following “best practices” are in place at the worksite.

Best Practices for Hand Hygiene

1. Healthcare workers demonstrate knowledge of the key elements of hand hygiene practice which are:

A. If hands are not visibly soiled, decontaminate with an alcohol-based hand rub:

  • Before and after direct contact with patients.
  • Before and after invasive procedures.
  • After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings if hands are not visibly soiled.
  • After removing gloves.

B. Wash hands with soap and water:

  • When hands are visibly dirty or soiled with blood or other body fluids.
  • When caring for patients with diarrhea like illnesses.
  • Before eating.
  • After using the restroom.

C. Wear gloves when in contact with:

  • Excretions
  • Secretions
  • Mucous membranes
  • Non-intact skin.
  • Perform hand hygiene immediately after gloves are removed.
  • Change gloves when moving from a contaminated site to a clean site on the same patient.
  • Change gloves after caring for each patient.

2. Healthcare workers demonstrate appropriate hand hygiene techniques which include:

A.    Hand rubbing

  • Use an alcohol-based hand hygiene product (rub, gel, or foam). Antimicrobial-impregnated wipes (i.e., towelettes) are not a substitute for using an alcohol-based hand rub or antimicrobial soap.
  • Use enough to cover all surfaces (palm, back of hand, fingers, fingertips, and fingernails);
  • Rub until dry (at least 15 seconds).

B.  Hand washing:

  • Wash hands with soap and water, including contact with soap for at least 15 seconds.
  • Cover all surfaces including palm, back of hand, fingers, fingertips, and fingernails.
  • Rub with friction.
  • Use paper towel to turn off the faucet.
  • Dry hands with fresh paper towel.
  • Take gloves off inside out so the hands are not in contact with a contaminated glove surface.

C. Removing gloves

  • Take gloves off inside out so the hands are not in contact with a contaminated glove surface.

3. Hand hygiene supplies are available at the point of care.

  • Availability of alcohol-based hand rub at the point of care minimizes the time constraint associated with hand hygiene during patient care and is a predictor of better compliance.
  • The cost of hand hygiene products should not be the primary factor influencing product selection. Hand-hygiene products should have low potential for irritation.
  • Provide hand lotions or creams to minimize the occurrence of irritant contact dermatitis associated with hand antisepsis or hand washing.
  • Availability of gloves in appropriate sizes at the point of care for use in high-risk situations when barrier technique is indicated.
  • Sterile gloves are not required for this purpose.

Here are the answers to the questions about hand hygiene that were posted last week.  Did you use any of these as a test of knowledge for yourself or among your co-workers?  How did you do? Please share your experiences improving hand hygiene by responding in the comments section of this post.

Question 1: A Question 2: B Question 3: A Question 4: A
Question 5: B Question 6: B Question 7: A Question 8: A
Question 9: A Question 10: A Question 11: 4 Question 12: C
Question 13: C Question 14: D Question 15: 3 Question 16: C

For more on hand hygiene in the correctional setting please refer to the Essentials of Correctional Nursing particularly Chapter 4 in relation to patient safety and Chapter 10 as part of the discussion about infection control.  You can order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

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What is Your Hand Hygiene IQ?

800x600Last week we shared information about health care organizations that had improved compliance with best practices for hand hygiene into the 90% range.  If patient safety (i.e. reduction in healthcare acquired infection) is to be accomplished hand hygiene must become highly reliable. One of the measures to monitor and improve hand hygiene the Institute for Healthcare Improvement (IHI) recommends is that healthcare workers demonstrate their knowledge of the key elements of hand hygiene practice.

Below are 16 questions so that you can test your knowledge about hand hygiene. Next week the answers will be posted. You could pick perhaps five questions and post them in the workplace or pass them out at a staff meeting to generate discussion among your colleagues.  The IHI recommends only using a few at a time so that people are not burdened by the exercise. All of the possible questions are listed here so you can choose how you want to use them.

1. If infectious matter gets on your hands:

A. The sooner you wash it off, the less chance you have of getting infected.

B. It is okay to wait as long as you wash it off when you can get to it.

2. The Centers for Disease Control (CDC) recommends that healthcare professionals was their hands with soap and water for at least:

A. 30 seconds

B. 15 seconds

C. 20 seconds

3. According to the CDC the most effective way to reduce multi-drug resistant pathogens on the hands is to:

A. Use an alcohol based sanitizer.

B. Wash with warm water and soap.

C. Use prepackaged antibacterial wipes.

4. To reduce contamination after washing your hands turn off the faucet by using:

A. A paper towel.

B. Your elbow.

C. The top of the hand.

5. Which substances are considered most likely skin irritants:

A. Alcohol-based sanitizer.

B. Soap and water

C. Prepackaged antibacterial wipes.

6. Alcohol-based sanitizer is effective against Clostridium difficile.

A. True

B. False

7. Glove use when in contact with patients is a useful strategy in reducing transmission of infectious organisms.

A. True

B. False

8. How often should you clean your hands after touching a patient?

A. Always

B. Often

C. Sometimes

D. Never

9. How often should you clean your hands after touching an environmental surface in a patient care area?

A. Always

B. Often

C. Sometimes

D. Never

10. Artificial nails worn by a healthcare worker poses an infection risk for patients.

A. True

B. False

11. In which of the following situations should hand hygiene be performed?

A. Before direct contact with a patient.

B. Before an invasive procedure.

C. When moving from a contaminated to a clean body site.

D. After direct contact with a patient

E. After removing gloves.

     Answer choices:

1. B and E

2. A, B, and D

3. B, D, and E

4. All of the above

12. Which of the following is most effective in reducing bacteria on the hands when they are not visibly soiled or contaminated?

A. Washing hands with plain soap and water.

B. Washing hands with antimicrobial soap and water.

C. Using alcohol-based sanitizer and rubbing until dry.

13. How are antibiotic-resistant pathogens most often spread among patients in healthcare settings?

A. Airborne transmission from coughing and sneezing.

B. Contact with contaminated equipment.

C. Inadequate environmental sanitation.

D. Contamination on the hands of clinical staff.

14. Hand hygiene including proper use of gloves prevents transmission of the following  to healthcare workers:

A. Herpes simplex virus

B. Methicillin-resistant Staphylococcus aureus

C. Hepatitis B

D. All of the above

15. Which of the following pathogens survive in the patient care environment for days to weeks?

A. Escherichia coli

B. Klebsiella spp.

C. Clostridium difficile

D. Methicillin-resistant Staphylococcus aureus

E. Vancomycin-resistant enterococcus

     Answer choices:

1. A and D

2. A and B

3. C, D, and E

4. All of the above

16. Which of the following statements about alcohol-based hand sanitizer is most accurate?

A. It dries the skin more than washing with soap and water.

B. It causes more allergy and skin irritation than products made with chlorhexidine gluconate.

C. In the presence of a pre-existing skin condition it can cause some stinging.

D. It is effective when hands are visibly soiled or contaminated.

E. It destroys bacteria more slowly than antiseptic soaps.

Do you have some hand hygiene questions you would add to these? What ideas do you have about how to generate interest in improving hand hygiene knowledge and practice? Please share them with others by responding in the comments section of this post.

For more on hand hygiene in the correctional setting please refer to the Essentials of Correctional Nursing particularly Chapter 4 in relation to patient safety and Chapter 10 as part of the discussion about infection control.  You can order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

Photo Credit: provided courtesy of Novant Health at http://www.washinghandssaveslives.org/download/

Hand Hygiene: A simple habit embedded in the complex process of care.

800x600Last month the Institute for Healthcare Improvement (IHI) sponsored a discussion about what it takes to improve healthcare workers compliance with recommended hand hygiene practices.  Less than 50 % of the healthcare workforce demonstrate adherence to hand hygiene procedures. Reasons for non-adherence include:

  • Skin irritation
  • Use gloves instead
  • Equipment & supplies not accessible
  • Forgetfulness
  • High workload-understaffing
  • Patient need for care was a higher priority
  • Lack of knowledge
  • Insufficient time
  • Interferes with the patient relationship

What do you think the rate of adherence with hand hygiene practices is within the healthcare program at your facility?  Have you experienced difficulty carrying out proper hand hygiene in your practice? If so was it because of any of the reasons listed above? See a post from last August on the challenges of hand hygiene for correctional nurses at Correctional Nurse.net.

In the last several years the World Health Organization, the Joint Commission and the Centers for Disease Control (CDC) have targeted reduction in healthcare acquired infection as a primary patient safety goal.  The proposed standards for patient safety in prisons include the recommendation that correctional facilities comply with all category 1 recommendations in the CDC’s hand hygiene guidelines.  The reason the Institute for Healthcare Improvement (IHI) held the forum last month was to discuss how some facilities have increased hand hygiene adherence into the 90% range. The main points from this discussion were that hand hygiene is a habit that develops well before the professional training of health care workers and that while it is a simple task; it is embedded in the very complex process of patient care.

Organizations which have achieved these high adherence rates took these three steps:

  • Bring awareness of hand hygiene to the front of the mind.  Developing posters, screen reminders and simple signs to remind healthcare workers to wash their hands. In one facility the nurse manager writes a simple reminder on the white board in every patient room every day. Here is one of many resources for such reminders: http://www.washinghandssaveslives.org/download/
  • Link patient-centeredness to hand washing. Another facility mapped the process of care delivery and found that hand hygiene did not take place because it interfered with greeting the patient and bringing supplies into the room. The corrective action involved moving a privacy curtain and identifying more appropriate hand hygiene products available at the point of care.
  • Hold healthcare workers accountable for avoiding harm. One of the facilities described coming to an understanding that compliance rates were simply an average.  When they realized that while some staff were very adherent others were less compliant or not at all, a more individualized and targeted approach to improving hand hygiene was initiated. An audit procedure was established to observe healthcare workers and to provide individual, specific feedback on compliance. Providing feedback was described as an opportunity for a conversation that was sincere and serious. Failure to improve was escalated up the chain of command but still treated as an important conversation. By focusing on individual knowledge and practice competency, overall compliance rates increased.
  • Demonstrate that avoiding harm is a priority. Leadership needs to demonstrate the priority of hand hygiene in patient safety.  Already described were nurse managers putting new reminders in patient care areas every day. Another example is a CEO who tests knowledge of staff about hand hygiene while on rounds at the facility.  He selects five questions each week to keep the dialogue around hand hygiene fresh and interesting.

Share your thoughts about how to improve hand hygiene practices in correctional nursing practice by responding in the comments section of this post.

For more on hand hygiene in the correctional setting please refer to the Essentials of Correctional Nursing particularly Chapter 4 in relation to patient safety and Chapter 10 as part of the discussion about infection control.  You can order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping. 

Photo Credit: provided courtesy of Novant Health at http://www.washinghandssaveslives.org/download/