From the minute Debbie Martoccio, RN, BSN, MBA, CNAA-BC, vice president of patient care and chief nursing officer at University Community Hospital, Tampa, saw the prototype for Medline’s Hand Washing Competency Validation Kit last year, she couldn’t keep her hands off of it. And when she introduced one of the beta test models at the hospital in April, the staff felt the same way.
“I saw the prototype for the kit and I said, ‘Wow, I could use that!’,” says Martoccio. The portable kit, which was rolled out at UCH and sister facility UCH-Carrollwood in mid-April, is believed to be the first of its kind in Tampa Bay hospitals and, according to Marc Lessem, divisional vice president at the device’s Illinois-based manufacturer, Medline Industries Inc., it provides a reliable way to validate competency for staff being trained on proper techniques for hand antisepsis.
The kit works by adding 10 mls of the company’s liquid Visirub, a fluorescent marker used for demonstration and training purposes, to a 500 ml bottle of Medline’s alcohol-based, waterless hand sanitizer Sterillium Comfort Gel, and applying the proper volume of the mixture to the hands. Then the hands are placed into a small box affixed with a black light clipped to the top, which gives visual confirmation on how well the mixture was applied and what spots were missed.
“You can see instantly. Did you apply it to both hands and did you get under the fingernails as well as other commonly missed areas, like the thumb and interdigital spaces?,” says Lessem.
If used properly, under the black light, the validation kit’s user will see a chalky substance on his or her hands that shows where the product was applied properly. If an area does not have that chalky look, it indicates a gap in coverage.
Lessem says Medline’s kit is the first of its kind that can be added to an alcohol-based sanitizer and provide feedback on how well the product has been applied. “Evidence supports the use of alcohol-based hand sanitizing gels, but healthcare workers must also be trained on proper application technique,” he says. “We ought to be training healthcare professionals to put gel in the palm of one hand and dip the fingertips of the opposite hand into the pools before spreading the gel, then repeat with the other hand and fingertips. Utilizing this application technique addresses the areas of the hands [fingertips] where high counts of microorganisms can be found.”
The immediate feedback provided by the kits makes them useful to the staff at UCH, says Jackie Whitaker, RN, NPSG, infection control director and national patient safety goal administrator at the hospital. “We used to use this UV glow light that was a stand alone that you had to walk up to and it was bulky, but with the kit you can pick it up and take it with you.” UCH ordered 20 kits (with five going to Carrollwood).
When the unit patient safety officer in the ICU took one out and demonstrated it for the staff, “everyone walked by asked what it was, and the physicians, nurses, and transport staff all got hooked into seeing how well they were washing their hands,” Martoccio says.
Hand washing affects bottom line
With government reimbursement for hospital-acquired infections ending later this year, Martoccio says the pressure is on for hand-washing compliance to fall into line. Among the U.S. Centers for Disease Control’s recommendations are periodic monitoring of hand hygiene adherence, providing feedback to personnel regarding their performance, and monitoring the volume of alcohol-based hand rub used per 1,000 patient days.
Whitaker says unit patient safety monitors have electronic monitoring tools to check hand-washing compliance and scan that information into a database monthly, with the information reported up to the hospital’s board.
The goal of the UCH program is to increase hand-washing compliance given that 70% of infections are spread through the hands, but Martoccio says it is also to fall in line with goals set out by the Joint Commission to reduce hospital infections. Among those goals are for hospitals such as UCH to fall in line with CDC and World Health Organization hand-hygiene guidelines. “The Joint Commission says you need to have measures in place that allow you to monitor your compliance of your medical and clinical staff with hand hygiene,” Whitaker says.
Between the 53 unit patient safety officers at UCH and the 10 at Carrollwood, Martoccio says she could easily have ordered 50 kits and still not had enough to satisfy demand. Once the units are available for sign-out, the officers will be able to obtain one for a week and then return them so that they can go to another unit.
Because UCH is part of a pilot program for the use of the compliance kits, the demonstration kits are being provided to them at no cost. Lessem estimated that the implementation of the Medline kits (which include the box, the light, two vials of Visirub and a 500 ml bottle of Sterillium) would likely cost around $135 each. Though the kits have only been in use since December, he estimated that the life of the system should be “years,” with frequent refills needed for the liquid rubs.
Whitaker says one of the unit patient safety officers told her a story that indicated the kits are very likely improve hand washing behaviors. “One of the officers from one of our operating rooms put some Visirub on people’s lockers and then had them change clothes and 30 minutes later she gathered them in an administrative area and put a UV light on their hands,” she said. “She was trying to demonstrate how cross-contamination happens on all surfaces and on your body and clothing. People had no idea that cross-contamination could occur like this, so it was very effective.”
Gil Kaufman is a freelance writer.