It’s that Simple

Hôtel-Dieu Grace Healthcare solves common PPE challenges through cooperation, creativity

By Sarah Picco, Lindsay Samoila, Ray Elwood & Justin Quinn

In the words of American engineer Charles F. Kettering, “If you have always done it that way, it is probably wrong.”

This is exactly what the infection prevent ion a nd cont rol ( I PAC ) department at Hôtel-Dieu Grace Healthcare (HDGH) found with its personal protective equipment (PPE) storage. Regular quality checks identified that it did not facilitate best practices for donning or hand hygiene. Growing linen costs and lingering low hand hygiene compliance rates were also driving the need for a better PPE storage solution.

To find a better way, an inter-professional team was created that included IPAC practitioners, environmental services, materials management, frontline staff, ergonomics, clinical practice and plant operations. The team performed process auditing, focusing on best practices for hand hygiene and donning PPE. Sixtynine PPE carts were examined over a 12-month period.

The audits revealed extreme hoarding of linen, general hospital supplies and expired PPE. Manual replenishment of PPE without a def ined process of ownership, cleaning and maintenance was contributing to the hoarding and storage problem. The auditing process illustrated healthcare workers had their own ideas of the purpose of the PPE carts. As a result, the current storage system was contributing to missed hand hygiene opportunities and growing linen costs.

With the audit results in hand, the interprofessional team worked to determine what best practices indicate for PPE use and location. Various frontline staff were asked where and how they used PPE. From this, a list of criteria for ideal PPE storage at pointof-care was generated, followed by extensive consultations with vendors and suppliers. The team found it relatively straightforward to identify existing solutions with vendors for mask and glove storage and placement. Gloves were moved to in-room standardized wall storage holders and stocked in all sizes. Hand sanitizer dispensers were placed next to the storage units to enable staff to perform hand hygiene and change gloves at point-ofcare. In addition, based on a risk assessment for the hospital, only one type of facial protection (combination mask with face shield) is available to staff based on the patient population and care activities.

An existing solution for gowns was not as easy to establish. At HDGH, Level 2 impermeable launderable gowns are used. This required the team to collaboratively develop innovative storage for laundered gowns. After much research and analysis, the team decided on laundered bags stored on hooks outside of each room. The garments are delivered to HDGH in prefilled bags with 20 gowns. The gown amount was calculated based on ergonomic parameters related to weight, height of the hooks and number of gowns frontline staff use over approximately 12 hours.

Collectively, inter-professional team members used a ‘plan-do-study-act’ quality improvement cycle to develop and implement a permanent, self

sustaining point-of-care PPE storage system that promotes the appropriate donning sequence and four moments of hand hygiene.

Its impact was measured and indicated some significant changes, including a 27 per cent reduction in protective gown consumption, representing a cost savings of $24,707 in a one-year period; an eight per cent reduction in glove consumption, representing a cost savings of $56,000 over a three-year period; and a 10 per cent increase in hand hygiene compliance over the length of the two-year project.

By utilizing a collaborative team approach, point-of-care PPE was integrated into practice at HDGH. Incorporating frontline feedback into the design motivated healthcare workers to embrace it. The successful implementation validated great ideas can come from within the organization and innovation does not need to originate from external sources or be state-of-the-art.

Sarah Picco is manager of professional practice and infection control at HôtelDieu Grace Healthcare. Lindsay Samoila and Raymond Elwood are infection control practitioners at the southwestern Ontario hospital, and Justin Quinn is manager of environmental service and materials management.