In early 2020, when the world became aware of the COVID-19 virus, the information provided by the Centers for Disease Control and Prevention (CDC) was constantly being updated as the research developed. Therefore, with the limited amount of information available, it was paramount to ensure that health care teams were continually informed.
At O’Connor Hospital in Santa Clara County, California, two departments—Environmental Services (EVS) and Infection Prevention and Control (IPC)—worked together and successfully bridged the gap between EVS staff knowledge and the information they needed to act appropriately against COVID-19. The collaboration was especially crucial regarding hand hygiene.
The importance of proper hand hygiene
As Gina Nissinoff, EVS manager of O’Connor Hospital, explained, “Our main function is to clean and disinfect the hospital. This is how we keep people safe… When they come and stay with us, they’re able to heal. So, we have to have an environment that allows that to happen.”
As such, Nissinoff said all that EVS does is very specific to hand hygiene. “Touch is very important in our job. We have to be able to touch equipment. We have to be able to touch patients,” she said. “So, we wanted to make sure that we not only kept our patients safe and maintained the integrity of the hospital standards of the environment, but we also wanted to keep us, our families, and our teammates safe.”
A confusing, stressful beginning
According to Nissinoff, the early days of COVID-19 created a great deal of stress and confusion for her staff. “At the beginning of the pandemic, we knew what the public knew. It was very scary. It was very hard on all of our teams.”
“We felt like we were almost in a war where we couldn’t see,” she continued. “Information was changing, guidelines were changing.”
Although the EVS team was good at following hand hygiene protocols before the pandemic, it quickly became evident in the light of COVID-19 that the team had to get even better. That meant learning more and doing some things differently.
A successful collaboration based on reason
“I’ve worked in EVS for about 20 years,” Nissinoff said, “but I’ve never worked with a very robust infection prevention and control team that’s led by Priya.”
Nissinoff is referring to Priya Pandya-Orozco, infection prevention and control manager of O’Connor Hospital.
“Priya has taught me—and our entire team—so much,” Nissinoff continued, “and we learned from a clinical perspective. It wasn’t just, ‘This is how you do it.’ We knew how to do it. But she took that concept and helped us grow it, and really gave us the ‘why’ we do it and what happens if we don’t do it…And that was the missing component. We want to understand why we do it.”
Pandya-Orozco confirmed the importance of workers understanding the reasons behind the COVID-19 protocols, as that knowledge helped combat the fear and anxiety that surrounded the virus. “People wanted to understand the disease—understand how to keep themselves safe,” she said.
Armed with that knowledge behind the new protocols, the workers felt much less lost and afraid. “When we explained that,” Pandya-Orozco said, “the level of calm across the hospital changed.”
Concrete actions made a difference
To make a meaningful difference within a time as challenging as the pandemic, Pandya-Orozco said everyone, from leadership and management to the frontline staff, was involved in the education efforts. Hospital leadership also made clear to workers that their feedback was extremely valuable and welcomed.
“Infection control along with executive leadership…every support service, every department and unit…We were huddling all day, every day,” said Pandya-Orozco. The hospital CEO and CNE (Chief Nursing Executive) were walking the floors of the hospital daily, huddling with staff and listening to their questions—EVS staff saw that.”
To help workers navigate through the uncharted nature of the disease, the hospital implemented the COVID Tiger Team, who were registered nurses available on every floor during all shifts who could help with any question a staff member may have about COVID-19.
But the first step in keeping everyone safe was—and continues to be—the fundamental basis of good hand hygiene. To ensure that everyone was consistently following the right steps, infection prevention and control provided training—including helpful demonstrations—to all EVS staff on maintaining good hand hygiene, as well as other important COVID-19 protocols, such as the proper wearing of all personal protection equipment (PPE) and the correct use of involved chemicals.
This education was important because, before the pandemic, EVS workers didn’t always have a robust education on hand hygiene. But once the hospital found itself in the trenches of the pandemic, a tight-knit cooperation between the departments made the difference toward better compliance.
“The really close collaboration with EVS leadership, and leadership with Infection Control, was the key,” Nissinoff said. “Once people understood and had received the education, they felt more empowered to do their jobs.”
This included working on cleaning techniques as well—how to clean beds properly, how to wipe down surfaces, and how to use new chemicals in a safe and proper manner.
According to Nissinoff, once the workers saw the improved results of the new techniques, in conjunction with all their training and education, they also witnessed several other positive changes. For example, the rate of other infections, such as C. difficile, went down. Ultimately, workers’ fears surrounding COVID-19 began to slowly dissipate, while they felt much more supported and empowered.
A supportive and responsible culture
Thanks to the hospital’s Healthcare Associated Infection (HAI) taskforce, made up of both frontline staff and nursing leadership—a supportive “speak-up” culture began to develop, Pandya-Orozco said.
Out of the HAI taskforce, a competition was created—called the “Phrase that Saves”—that asked staff to come up with their own phrase to encourage others to perform hand hygiene. This led to the creation of the “Clean20” phrase. Now, anytime someone notices that there is a missed opportunity to perform hand hygiene, they say this phrase to serve as a compassionate and kind reminder.
For complete transparency, all hand-hygiene data has been forward facing and shared with all patients for more than a year now. “When you walk into any unit, you can see the percentage of the hand-hygiene compliance on that unit, and in every patient room, it is posted,” Pandya-Orozco said. “It’s altogether a different process when you have to actually, physically, write the hand hygiene compliance number on the board. It’s meant to really build that speak-up and share the accountability to perform hand hygiene which is everyone’s responsibility.”
COVID-19 challenges met with positivity
A unique aspect of O’Connor hospital’s COVID-19 efforts was the emphasis placed on staying positive, despite the overall negativity of the outbreak.
“It was very challenging, but we kept our head up. We keep smiling,” said Nissinoff.
According to Pandya-Orozco, staff regularly change the hand hygiene compliance posters with new designs throughout the hospital to serve as fun reminders to stay on task and remain compliant.
Another way the hospital staff managed to make a serious subject a little more light-hearted was via a video they created, designed to demonstrate proper handwashing in a fun, memorable, and easy-to-share format.
Thanks to an initial idea by the hospital’s infection prevention and control team, the hospital devised a contest for departments to create a hand hygiene flash mob video. The winning team received a prize and the winning video was entered into the Association for Professionals in Infection Control and Epidemiology (APIC) Film Festival—which took the Grand Prize for this year.
Hospital staff, patients, and visitors viewed the winning video, along with other submissions, on World Hand Hygiene Day (May 5) via posted QR codes. (To check out the video, click here.)
“Doing fun group projects like that is teambuilding,” said Pandya-Orozco. “We were in the height of the pandemic—going into another wave—and people were still smiling.”
Staff also focused on their hospital’s motto, “O’CONNOR PROUD”—a phrase that can be found in capital letters on a banner in the facility’s walkway—to keep workers united and spirits high amidst the struggles of the pandemic.
“That’s not just a slogan for us,” said Nissinoff. “That’s everything that every team member is about. That’s what really came out of this pandemic. We are O’Connor Proud!”
Going forward with new knowledge
While it might appear that the worst of the COVID-19 pandemic is behind us, that doesn’t mean these departments intend to do anything differently or go back to any old ways.
“Our processes are hard-wired,” said Nissinoff. “And because they’re effective, they work. That is structure and consistency and that really empowers the team.”