It’s common for infection preventionists to talk hand hygiene, which is very important, but how is stethoscope hygiene at your hospital? Chances are not very good.
The American Journal of Infection Control recently reported zero incidences of stethoscope hygiene out of 169 observations among medical students on rotation. The researchers expected the rate to be low, but there are several reasons that zero incidences is surprising. First, stethoscope hygiene is on the checklist for second year medical students. Second, and more disappointing, stethoscope hygiene rates did not improve after an education initiative.
After zero incidences of stethoscope hygiene out of 128 observations, the researchers intervened. They showed the students a stethoscope hygiene powerpoint with their attending physicians present and stated the students would be observed for compliance. The presentation seemed to be enthusiastically received. They also placed posters at the entrance to every nursing unit, and made boxes of alcohol swabs abundantly available for sanitizing stethoscopes.
In 41 post-intervention observations they still found zero occurrences.
The study highlights the fact that education and availability of supplies alone are not sufficient to encourage proper hygiene.
In my experience the involvement of medical leadership is required for significant change. It has to be a part of the culture, and culture change starts at the top.
But how do you get medical administration involved in promoting hygiene accountability in sustainable ways?
One way is demonstrated by a program at Vanderbilt University in Nashville Tennessee which was able to increase average adherence from 55% to over 85% for hand hygiene and sustain the improvement across the organization since 2011.
How do they accomplish this? In addition to marketing efforts they provide financial incentives to departments for increasing adherence. Departments can be refunded up to 2.5% of premiums paid into the hospital’s malpractice self-insurance and use the funds however they see fit.
Leadership across the institution stayed involved with hand hygiene accountability and gave observers the ability to intervene when hospital hygiene policies were not being implemented. Intervention started with a non-judgemental talk they termed a “cup of coffee” conversation. Intervention severity could increase from awareness to authority and finally disciplinary actions if patterns of non-compliance were not addressed.
The Vanderbilt example is helpful in demonstrating one of the ways medical leadership can affect sustained change. The particular circumstances may be different in your hospital (for example, the physicians may not be employees) but the essential point is that sustained improvement of hand and stethoscope hygiene will not occur without a complete culture change.
To see dismal stethoscope hygiene rates improve, more than observations and education are required. Culture change requires sustained involvement from medical administration. At Infection Prevention Services we’re always thinking about ways leadership and infection preventionists can collaborate more effectively for best outcomes.