ABOUT TARGET ZERO
In 2008, Shore Health System began a journey that many thought was impossible. The destination? Zero healthcare associated infections.
For several years, performance improvement teams made up of physicians, nurses and their colleagues around the system had been working to decrease the more common healthcare associated infections - infections that occur when a patient is being treated with a ventilator (breathing tube), a urinary catheter or an intravenous line through which medications are administered.
These teams achieved impressive results. However, most people thought some number of healthcare associated infections - even if very small - was inevitable.
That is, until the vision of Target Zero came into focus.
A Bold Vision
Martin Forrest, MD, (left) a pulmonologist for Shore Health System, works closely with the ICU nursing teams at Dorchester General Hospital and Memorial Hospital to prevent serious infections such as sepsis.
Sherri Taylor (second from left), a Patient Registration Representative in the Memorial Hospital Emergency Department, was a monthly Target gift card winner when she was observed washing her hands.
In 2009, Shore Health set a bold vision - the elimination of healthcare associated infections wherever we provide patient care.
The scope of Target Zero sets us apart from other organizations because, instead of focusing our efforts solely on the intensive care units of the hospitals, we invited all departments throughout the system - both in the hospital and out in the community, even in patient's homes - to aim for Target Zero.
The Bottom Line
Target Zero is about keeping patients safe, about doing the right thing each and every time. Infection rates are numbers, but every number is someone's loved one. Through Target Zero, we have eliminated many healthcare infections and sent our patients home to enjoy life with their loved ones.
Hand Washing, first and always
Hand hygiene - the most effective way to prevent the spread of infections - topped the list of Target Zero tactics. "Secret shoppers" trained by the Infection Prevention team began making the rounds at Dorchester General Hospital and Memorial Hospital looking for staff who were doing the right thing - washing their hands before and after every patient interaction. Compliance with hand hygiene practices rose and continues to rise as co-workers remind each other to wash their hands.
Ask me if I washed my hands
Target Zero went public in September of 2011, when the "Ask me if I washed my hands" campaign invited patients and visitors to ask their care providers, "Have you washed your hands?" Everyone is ready to respond with a smile and an enthusiastic, "Yes, I have. Thanks for asking!"
Members of the Shore Health Senior Leadership Team pledged their continued commitment by signing the "Ask me if I washed my hands" poster.
Nothing produces big wins like keeping score - and the reward of a party. We celebrate every time a patient care unit goes 12 months or more with no healthcare associated infections.
The nursing staff members in the ICU at Dorchester General Hospital are Target Zero champions, keeping their patients safe from ventilator associated pneumonia for more than 24 months. They also broke records for preventing infections in their patients being treated with urinary catheters and central intravenous lines.
No other Magnet hospital has done what the Multi-Specialty Care Unit at Dorchester General Hospital achieved: two years with no cases of catheter associated urinary tract infection and central line associated blood stream infection.
The Home Care and Hospice team set Target Zero milestones as they logged almost three years without a central line associated blood stream infections, more than two years without a surgical site infection and over 12 months without a reported case of MRSA (Methicillin-resistant Staphylococcus aureus.)
Physicians, nurses and housekeeping staff work together every day to prevent infections for patients recovering from surgery at Memorial Hospital.
The Memorial Hospital Multi-Specialty Care Unit earned special recognition for two years without a catheter associated urinary tract infection.
The Neuroscience Unit staff at Memorial Hospital celebrated 1,000 days without a catheter-associated urinary tract infection.
The staff in the Telemetry unit at Memorial Hospital were applauded for achieving zero catheter-associated urinary tract infections for over a year.
The Memorial Hospital Intensive Care Unit has gone over two years without a ventilator associated pneumonia case.
The Respiratory Therapy staff at Memorial Hospital has eliminated ventilator associated pneumonia cases for well over two years. They have eliminated this serious healthcare associated infection by consistently cleaning their hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator.
Other Ways to Zero
In 2010, Shore Health employees responded to the "100 Ways in 100 Days" campaign during which they were invited to submit ideas for eliminating healthcare associated infections.
Every idea was reviewed and many were implemented, including replacing stained ceiling tiles and soiled carpet in a nursing station. Housekeeping stepped up their regular cleaning routines in bathrooms, locker rooms, elevators and cafeterias. TV remote controls in ICU patient rooms were replaced with more sanitary pillow speakers. And more hand sanitizer dispensers were added to encourage staff and visitors to clean their hands.
Target Zero is Catching on
The news of Shore Health's Target Zero successes have spread fast and far.
- The Maryland Patient Safety Center invited our team to present Target Zero from the podium at their annual conference in April 2011.
- A poster highlighting the work of the Target Zero initiative was presented at the Magnet convention, sponsored by the American Nurses Credentialing Center, in October 2011.
- In April 2012, Shore Health was awarded the 2012 Minogue Award for Patient Safety Innovation
Click Here to see the official 2012 Maryland Safety Brochure announcing the award.
TARGET ZERO FAQ
What is Target Zero?
Target Zero is Shore Health System's commitment to preventing healthcare associated infections.
What is a healthcare associated infection?
A healthcare associated infection is an infection that a person gets after being admitted to a hospital or other healthcare facility. Patients can become ill with new infections that are primarily passed to them on the hands of healthcare workers or on equipment that has not been properly cleaned.
How are these infections prevented?
Hand hygiene is the number one way to prevent infections of all kinds, including healthcare associated infections.
Who is at risk for a healthcare associated infections?
Everyone who is admitted to the hospital or other healthcare facilities is at some risk for getting a healthcare associated infection. Some people who are very sick or have had surgery have an increased risk. Some patients are more vulnerable than others. They include:
- premature babies and very sick children
- the frail and the elderly
- individuals with certain chronic medical conditions, such as diabetes
- people with diseases that compromise their immune system or people who are being treated with chemotherapy or steroids
Other factors that may increase the likelihood of developing a healthcare associated infection include:
- a long hospital stay
- critical illnesses that lower a person's resistance to infection
- some operations and surgical procedures
- overuse of antibiotics, which can make these medications less effective
- use of medical equipment that enters the body, such as urinary catheters, intravenous drips and infusions, respiratory equipment and drain tubes
- wounds, incisions (surgical cuts), burns and skin ulcers, which are all prone to infection
What steps are we taking to reach Target Zero?
- Alcohol hand gel stations have been placed at the entrances to every Shore Health facility to encourage hand washing by staff, patients and visitors.
- Infection prevention nurses share their expertise with staff at all facilities.
- Infection prevention teams study medical literature and analyze data to continually recommend new ways to keep patients safe.
- Education is provided for staff and volunteers about how to prevent and control infections.
- Involve every employee, physician and volunteer. Reinforce that every member of the Shore Health team is responsible for controlling infections, and encourage staff to provide advice and support to the patients, visitors and members of the community.
Cardiologist Scott Friedman, MD, cleans his stethoscope before examining a patient.
Under the direction of a physician, the clinical team members who staff the hospital intensive care units meet twice a day to keep their eye on Target Zero.
WHAT CAN YOU DO?
Clean your hands
Use alcohol-based hand sanitizer if your hands are not visibly soiled. It kills 99.9 percent of all germs found on your hands. To use hand sanitizer effectively:
- Get one squirt from the hand sanitizer dispenser
- Rub your hands so that the gel gets on your nail beds, between your fingers and up to your wrists.
- Rub until dry.
Use soap and water if your hands are visibly soiled. To use soap and water effectively:
"We pick up all kinds of germs from the people and things we touch - yet a 15-second procedure can prevent an infection or save a life. When we wash our hands, we help eliminate the chance of a patient getting a healthcare associated infection." Julie Bryan, BS, RN, Infection Prevention Coordinator for Shore Health System
- Turn on the water and wet your hands.
- Get a squirt of soap from the dispenser.
- Rub your hands to get soap into your nail beds, up around your wrists and into the wrinkles on your knuckles. You need friction between your hands and the soap to loosen skin cells where germs like to hang on.
- Scrub for 15 seconds, the time it takes to sing one chorus of "Happy Birthday to you."
- Rinse your hands with water.
- Let the water keep running as you get a towel and thoroughly dry your hands.
- Throw away the soiled towel.
- Use a clean towel to turn off the water faucet so you don't contaminate your clean hands.
Smoking can interfere with healing. It also damages the airways, which can make lung infections more likely.
Maintain a healthy weight
People who are overweight are more prone to infection.
Tell your doctor of all existing or recent Illnesses
A cold or the flu can lead to a chest infection, so let your doctor or the hospital staff know if you are not well.
Keep track of your medications
Know the medications that you take. Let your doctor or nurses know all the medications you are currently taking, especially if any are antibiotics or steroids.
Get vaccinations to avoid disease and fight the spread of infection
Make sure that your vaccinations are up-to-date (even for adults). Check with your doctor about shots you may need.
During your stay in the hospital, these steps can help reduce your chance of infection:
"As healthcare providers, it is important to build a culture that ensures the highest standards of hand washing and infection control to ensure the safest care for all patients. It is such a simple practice but hand washing prevents disease and promotes wellness throughout the community." Hospitalist Ramesh Kolli, MD
- Wash Your Hands, especially after using the toilet and before and after meals.
- Ask everyone who visits you - including your doctors and nurses - to wash their hands.
- Tell family members to stay home if they are sick. It can be hard to keep some well-wishers and loved ones away. But remind them that if they are sick, even with a mild cold, that you prefer that they stay home until you've fully recovered.
- Anyone with a cough should wear a mask. Family and friends should postpone their visits when they are sick with an infection.
- Speak Up! Pay attention to what is going on around you. If you have questions or if something doesn't seem right, ask your doctor or healthcare provider about it.
When you leave the hospital, these steps can improve your health:
- Follow doctor's orders. Ask for your treatment plan before you leave the hospital. Follow all medical instructions carefully and completely, including how to take care of your wounds, what activities to avoid and how long to use antibiotics.
- Report signs and symptoms of infection. Pay attention to symptoms that may indicate an infection: unexpected pain, chills, fever, pus, drainage or increased redness or swelling around a cut or wound. Contact your doctor immediately if any of these occur.
Winners of the Target Zero Ask Me if I Washed My Hands song writing contest from left to right are Irene Hansen, BS, RRT-NPS, EEG Technician; John Hansen, Kim Billingslea, Director, Patient Safety and Advocacy for Shore Health System; Cynthia Gullion, RN, Shore Works; Renee Jeffries, Surgical/Ambulatory Informatics Manager; John Jacobs, RN; and Gary Jones, RCP, FAACA, Director of Cardiovascular and Pulmonary Services.
Clean hands are something to sing about
Shore Health recently announced the winners of its Target Zero songwriting contest.
The Target Zero steering committee received 13 song entries, all themed at spreading the word about hand hygiene and its important role in the prevention of healthcare associated infections. Entries were judged on creativity, originality and how well the lyrics conveyed the message of Target Zero by members of the Target Zero steering committee. The winners are:
Song #2 - Contest Winner >>
First Place: Cindy Gullion, RN, a nurse for Shore Works, was named the winner of the Target Zero songwriting contest. Gullion's entry featured her own original music and lyrics. Gullion is part of a singing ministry duo who perform at churches and other events throughout the Mid-Shore.
Song #1 - Runner Up >>
Runner Up: Irene Hansen, BS, RRT-NPS, EEG Technician, who recorded her own Target Zero adaptation of the Supremes' hit "You Can't Hurry Love," replacing the main chorus with "You Must Wash Your Hands."
Song #3 - Runner Up >>
Runner Up: John Jacobs, RN; and Gary Jones, RCP, FAACA, Director of Cardiovascular and Pulmonary Services received runner up honors for their reggae-inspired, highly dance floor worthy "You've Got to Wash Your Hands."
In addition to receiving a $250 prize for her efforts, Gullion will also get the honor of seeing her song made into a video later this year.
Congratulations to Gullion and all the entrants for their great work and continued commitment to the Target Zero mission.