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BEST PRACTICES
October 2021

How to control infections by driving shared accountability

It takes a village, plus a good change management strategy.

Three people with masks on

You’re an infection preventionist, and you’re seeing that the numbers for certain healthcare-acquired infections (HAIs) have been creeping upward in your organization. In getting to the root cause of a recent central line bloodstream infection (CLABSI) event, you’ve discovered that the clinician who was inserting a central line at the bedside touched a bed rail that hadn’t been wiped down and then touched the patient. In the meantime, staff are in short supply or stretched thin, and they don’t have the time or tolerance at the moment to take on one more project.

It’s quite a picture. Infection preventionists are challenged every day to meet expectations set by the Centers for Medicare and Medicaid Services (CMS) and other payors, not to mention their own organizations, to reach zero harm when it comes to preventing HAIs. And while the Centers for Disease Control and Prevention (CDC) reports significant progress in preventing some types of HAIs, on any given day about one in 31 hospital patients has at least one healthcare-associated infection.1

Angela Zuick, Medline Director of Clinical Services

“The role of infection preventionist is branching out beyond acute-care to other providers—long-term care, post-acute care and rehab are increasingly being tasked as active participants in infection prevention. Not to mention a ton of external factors that are playing a part like COVID, which unfortunately is making it more apparent to everyone the failures of the system.”

Angela Zuick, Medline Director of Clinical Services

Key factors getting in the way of a successful infection prevention strategy include:

  • Pathogens that cause disease are everywhere, with new ones on the rise (for example, COVID and the Delta variant), and others are becoming increasingly complex, making it more and more challenging for staff to prevent their spread.
  • Patients are more complex, and with that, so is the care they require. Best practices are changing and evolving at an impossible pace, even by healthcare standards.
  • Even in hospital cultures that place a high priority on patient safety, collaboration, and employee engagement and accountability, staff members are juggling multiple priorities during an unprecedented time in healthcare—one marked by a public health crisis and ongoing nursing shortages.
  • Transitioning patients from the acute to post-acute care setting is increasing both the risk for infection and the expectations for prevention, especially among large IDNs that own and operate not only hospitals but also rehabilitation, long-term care facilities and home care services.

The Joint Commission, the Association for Professionals in Infection Control and Epidemiology (APIC) and other organizations have clear guidelines for best practices in preventing CLABSI, catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), hospital-onset C. difficile and hospital-onset MRSA.

Yet no one person can prevent these HAIs. Everyone needs to be engaged and involved to keep patients safe—from physicians and bedside nurses to clinicians in ancillary units, to the EVS teams responsible for keeping patient rooms clean, to materials managers responsible for supplying the right products.

But how do you influence people, most of whom don’t report to you, to follow best practices? How do you drive shared accountability across teams to prevent infection?

Change management—your choice of models and best practices

Just as there are best practices in infection prevention, the same holds true for change management, which according to Harvard Business School, “drives the successful adoption and usage of change” within a business. Without it, transitions can be “rocky and expensive” and, ultimately, lead to failure.2 In fact, as hospitals and health systems, especially large and growing IDNs, continue to evolve and adapt to new caregiving models, many are already using process improvement and change management tools and methodologies to transform their organizations.

If you Google “change management,” you’ll find a litany of models to choose from. In one article, the Kotter Change Management Model, the McKinsey 7-S Change Model, and the Prosci ADKAR® Change Management Model come up as among those considered most effective in the healthcare setting.3

If your organization is already using one of these or another change management model, your best bet is to use the same. This way, physicians and staff, some of whom may wind up on your team, will already be familiar with the model’s change management concepts. And while their structures and approach may vary, most all change management models involve key principles or concepts that are essential to successfully driving shared accountability among team members.

Take, for example, the five sequential building blocks to the ADKAR® model. Here are some ideas for how you can put these building blocks to work in infection prevention:

awareness

1 | Awareness of the need for change

“Building awareness means clearly explaining the drivers or opportunities that have resulted in the need for change. It also means addressing why a change is needed now and explaining the risk of not changing.” 4

  • Use key measurements such as the standardized infection rate (SIR) to raise awareness, show people how a hospital compares to national baseline data and help make the case for change. “If the rates aren’t shared with staff, they have no idea,” says Donna Matocha, Medline Clinical Resource Manager. “The more hospitals communicate these rates, the better.”
  • Use “zero harm” to raise general awareness and keep top of mind the organization’s priority of high-quality care and patient safety.
  • Link your infection prevention initiative to the strategic goals of the health system or to external dynamics requiring change in healthcare or the local market.5
  • Invite a third-party expert, who team members will see as non-threatening, to assess your organization’s current state and identify gaps in your infection prevention plan and processes.
shared accountability desire

2 | Desire to participate and support the change

“Continuing to focus on the reasons for change and not translating those into the personal and organizational motivating factors is a trap some change management practitioners face, and it can be very discouraging and annoying for employees. Your change management will require artful use of leaders as sponsors of change, and of supervisors and managers as coaches of employees during the change process.” 6

  • Empathize with key stakeholders—physicians, frontline caregivers and workers, EVS workers and supply leaders—by acknowledging their conflicts and/or concerns. Underscore the important role they play in keeping patients safe from infection through training and education and engage them in the development of a common purpose and plan.
  • Recruit physicians, nurses, EVS managers and materials managers as partners in new initiatives and/or to serve as champions for each group.
  • Invite senior leaders’ engagement and involvement at the onset of any program or project. Those most influential in preventing HAIs are the CNO and CMO but also unit managers, service chiefs, hospital epidemiologist, infection preventionists, environmental services and facilities managers.7

3 | Knowledge on how to change

“…there are two distinct types of knowledge. The first is knowledge on how to change (what to do during the transition), and knowledge on how to perform effectively in the future state (knowledge on the ultimate skills and behaviors needed to support the change).” 8

  • Consider a two-tiered approach to defining best practices for infection prevention, with the first tier focused on standardizing both products and procedures and the second as a backup plan consisting of interventions if infection rates remain high.9
  • Involve clinical educators, nurse preceptors and/or representatives from your organization’s learning and development team early on in your change management initiative. That way you can tailor training and education to the specific needs of a unit and/or product as well as facilitate the process.
  • Make sure everyone at every level understands the three zones or areas where infection prevention is transmitted—1) environment of care, 2) human-to-human contact and 3) clinical practice—and practices infection prevention consistently.
  • Connect the dots for frontline clinicians and workers by showing them how other routine best practices—good hand hygiene, in particular—are essential to the cause of keeping patients safe.
shared accountability ability

4 | Ability to implement desired skills and behavior

“There is often a large gap between knowledge and ability. Ensure that in addition to training to impart knowledge, employees are given sufficient tools for building their own ability.” 10

  • Encourage frontline staff to share their ideas for change and innovation, particularly when it comes to identifying gaps and standardizing evidence-based processes.
  • Foster a bedside culture where staff are trained and empowered to call out in real time oversights or mistakes in infection prevention processes without retribution from physicians or managers.
  • Leverage unit-based nursing councils and nursing practice councils. They have enormous influence when it comes to selecting new products and processes for preventing HAIs on their respective units as well as training and educating staff.
  • Take advantage of training and education materials and expertise offered by medical supply vendors when converting to new products.
shared accountability reinforcement

5 | Reinforcement to sustain the change

“As the final building block of successful change, the focus on reinforcement needs to remain strong so that changes are sustained and deliver expected results over time.” 11

  • Make HAIs a regular agenda item in multidisciplinary team meetings, staff huddles, patient rounds and other meetings attended by key stakeholders. Invite those directly involved in successes to share their stories exemplifying best practices in infection prevention.
  • Create and prominently post a KPI (key performance indicator) or similar tracking board for HAIs, hand hygiene posters and other key visuals. This will keep infection prevention best practices top of mind on units and drive compliance.
  • Recognize and reward individual and team wins through shout-outs and award nominations, as well as through storytelling in meetings and other organizational communications.

Key takeaway

Vigilant use of change management principles and concepts are essential to successfully engaging and involving clinicians and frontline staff to work as a team and drive shared accountability when it comes to controlling infections. And while it takes a collaborative spirit and everyone’s involvement, don’t underestimate the influence you have with people as they get to know you and understand that what you’re trying to achieve is in their patients’ best interest and theirs. “The really good infection preventionists are proactive in identifying opportunities for improvement before there’s a problem,” says Zuick. “They’re coming on the units to audit practices, talking to staff—being visible. Once they recognize it, nursing directors and staff will welcome and come to rely on your expertise.”

Looking for more ways to fight infection or interested in an assessment?

Reach out to a Medline Infection Prevention rep for more information.

Learn how to fight the spread of pathogens with a 3-zone defense strategy.

Create a culture of safety and prevention with the right tools and resources.

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