To encourage compliance, hospital administrations often intensify their education efforts and establish policies for enforcement with gradually accelerating consequences for non-compliance. Hospitals are driven by changes in policy, like Medicare’s Pay for Performance initiative that rolled out in October 2007. Now, Medicare will no longer reimburse for treating infections in patients that were not part of the condition for which they were admitted. Not only are many private health insurers taking action similar to Medicare’s and refusing reimbursement of treatment for HAI’s, but hospitals cannot pass off treatment costs to patients either.

The movement toward reporting hospital infection rates increases pressure on administrators to push for maximum compliance on prevention standards. Many states have mandated public reporting of hospital-acquired infections. The CDC also gathers infection rate data from hospitals reporting to state health officials through a surveillance system called the National Healthcare Safety Network (NHSN), making infection rate data readily accessible.

Today, the use of Personal Protective Equipment is increasing over what it was only four years ago, their use expanding throughout the hospital setting. Compliance has become an ongoing priority as hospitals, increasingly aware of the growing costs of treatment and the consequences on their own fiscal health are putting greater emphasis on finding new and effective ways to lower infection rates.

The CDC’s Guidance for the Selection and Use of Personal Protective Equipment in Healthcare Settings defines personal protective equipment (PPE) as one of four parts of the hierarchy of prevention, and "very important for protecting healthcare workers from disease transmission."1 PPE- gloves, gowns, masks, goggles and respirators- are the basic components of any prevention strategy addressing HAI when consistently used.

The CDC stresses hand hygiene in between tending to patients, along with proper donning and doffing of PPE. The biggest challenge when changing gloves is making hospital workers aware of what they touch before coming in contact with a patient. For example, a healthcare worker who empties a patient’s bed pan will need to change gloves before physical contact with the patient. Consider the risk of cross-contamination if that staff member was to then administer an I.V.

Easy accessibility, easier compliance

If compliance to standards is a big part of the challenge, the other part is consistency. The easy, convenient availability of PPE increases the likelihood they’ll be used consistently. In the hospital setting, PPE can often be spread in various locations around a room or floor, rather than one specific place. One way to help healthcare workers meet compliance is to make PPE available in an easily accessible area that is also well stocked. Some hospitals place containers where PPE’s are stored that in a conspicuous location that also serves as a visual compliance reminder.

Visually reminding staff about compliance is an effective way of helping increase the use of PPE’s. Critical in this instance is ensuring the container or location where PPE’s are dispensed is continuously stocked. Otherwise, the healthcare worker must locate where each item is stored, wasting valuable time in their day. Mobile workstations, another option for stocking and dispensing PPE’s, can also offer the visual reminder and increase the frequency of PPE use while reinforcing the importance of infection prevention.

Mobile workstations are a great way to provide extra storage on the unit’s floor. This helps staff avoid searching storage rooms and taking time from patients and duties. Mobile units now available can be placed in easily accessible locations or wall-mounted, putting PPE within easy reach. Some mobile workstation models feature antimicrobials for hand hygiene before and after donning and doffing, as well as mechanical innovations such as cuff-first glove dispensing to avoid contaminating PPE stored in the workstation when caregivers are accessing supplies.

Education plays a significant role in bringing awareness to the forefront and helping hospitals meet their own internal compliance policies. A high percentage of hospitals have infection control training healthcare workers are required to attend each year to remind them of the importance and proper use of PPE’s.

The good news is that many healthcare workers are becoming more aware of the importance of proper donning and doffing, a trend for the better. Making gowns, masks, and gloves readily and conveniently accessible, supports positive habits like changing gloves with each patient. For hospitals pressed to lower infection rates in the face of accelerating costs, consistent compliance with infection prevention standards can often be a matter of simply putting compliance within easier reach.

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