13-­‐08-­‐12   Crossing a red light ...
13-­‐08-­‐12     ...
13-­‐08-­‐12   a   •  Resistant to good advice MulI-­‐Resistant     ...
13-­‐08-­‐12  If hospital bugs would look like this – compliance with hand hygiene would be 100% ...
13-­‐08-­‐12  •  Education ...
13-­‐08-­‐12   ...
13-­‐08-­‐12  •  Economist, political thinker, philosopher - reputed to have been the last man to know everything there...
13-­‐08-­‐12  •  Implementation of hand hygiene as an •  Providing a safe envi...
13-­‐08-­‐12   InfecIon  control     ...
13-­‐08-­‐12   Single  control   ConInious  control   ...
13-­‐08-­‐12   You  need	...
13-­‐08-­‐12  •  Most people have a strong desire to look consistent within their words, beliefs, attitudes•  Whenever ...
13-­‐08-­‐12   Compliments  •  “We like people t...
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Namibia ICAN 2011

Behavioral aspects in infection control
Published on: Mar 3, 2016
Published in: Health & Medicine      Business      Travel      
Source: www.slideshare.net


Transcripts - Namibia ICAN 2011

  • 1. 13-­‐08-­‐12   Crossing a red light It’s mandatory in Germany It’s a suggestion in France3rd IPCAN Conference It’s Christmas decoration in Italy Barry  Cookson                        “Cheap  &  safe  is  possible  !”   •  would you trust these people to fly with them (put your life in their hands) 1
  • 2. 13-­‐08-­‐12     Why  aren’t  the  HCWs     doing  what  we  ask   them  to  do?      … the pilot will be among the dead Andreas  Widmer   How  can  anyone  miss  something  so  big?   2
  • 3. 13-­‐08-­‐12   a   •  Resistant to good advice MulI-­‐Resistant     •  Allergic to professional guidelinesMedical  Specialist   •  Non-compliant with infection control •  Blind to nosocomial infections •  Other priorities *  not  only  physicians  but  includes  nursing   …  we  don’t  see  that  we  put  a  paIent  at  risk!     3
  • 4. 13-­‐08-­‐12  If hospital bugs would look like this – compliance with hand hygiene would be 100% Problem Solution Combined « I don’t » Combined solutions I don’t know how to do it Education I don’t have the resource(s) System change I don’t do it Motivation•  Education•  System change•  Motivation pull School for the highly intelligent 4
  • 5. 13-­‐08-­‐12  •  Education 8 , %) 65•  System change Patient-to-nurse ratio ( pediatrics 7 Compliance with hand hygiene (•  Motivation medicine 6 55 surgery 5 4 45 ob / gyn 3 ICU 2 ) 35 1 8 12 16 20 Opportunities for hand hygiene per patient-hour of care ICU  12  HCWs    -­‐    40%  compliance    -­‐  4h  of  handhygiene   Time  60-­‐80  sec   Time  15-­‐30  sec   At  100%  compliance   At  100%  compliance   16  h  of  handhygiene   4  h  of  handhygiene   •  Education •  System change Stress kills IC •  Motivation 5
  • 6. 13-­‐08-­‐12   Disinfect your hands you murderer! >150  years  of  blame  were  not   Semmelweis  “schlepping”  his  colleagues  to  disinfect  their  hands   really  successful   Onya, the Redskins cheerer (who asked that her last•  Presenting something new and improved name be withheld, citing does not automatically change bahavior ! team policy), has her picture on the teams Web site in her official bikini-like uniform and•  ‘The lesson from marketing is that people are also reclining in an actual more willing to change their behaviour when bikini. Onya, 27, who declined to identify the they feel good, flattered, challenged company she works for, is but powerful, sexy or proud, than when they one of several drug are flooded with facts’ (Hodgkin 1999) representatives who have cheered for the Redskins •  Presenting something new and improved does not automatically change bahavior ! I want evidence ! 6
  • 7. 13-­‐08-­‐12  •  Economist, political thinker, philosopher - reputed to have been the last man to know everything there was to know in the world Do  we  need  RCTs  for  all  measures?   Those  who  insist  that  all  intervenIons  need  to   be  validated  by  a  RCT  need  to  come  down  to   earth  with  a  bump   Volu Contr nteer   ol  gro up   Smith & Pell BMJ 2003 P  <  0.01   SARS   Pre-­‐SARS   Post-­‐SARS   You do agree with me that we do not want to cause an epidemic ?! Clin  Infect  Dis    2004;39:511-­‐516   7
  • 8. 13-­‐08-­‐12  •  Implementation of hand hygiene as an •  Providing a safe environment for patient institutional “must” care is a corporate responsibility, thus•  Frequent observation and reporting of non- understaffing is corporate negligence! compliant HCWs (hospitals have been successfully sued for•  Initial warning by department head inadequate nursing staff and facilities)•  Punishment (salary decrease, stop work) They  received  100%  compliance  within    a  year,     but  do  we  like  the  idea   George  Annas    NEJM  354;19:2063-­‐2066   •  Encourage a blame-free culture of safety orientation toward improving systems rather than blaming people •  Right balance between blaming mistakes on systems (overwork, education, access to hand- rubs) and holding individual providers accountable (failure to follow clear rules in the face of well functioning systems = “violation”) •  Violations in industry (airline, computer chips) versus health-care Goldman NEJM 2006;355:121-122 Make HCW accountable + feel responsible! Goldman    NEJM    2006;355:121-­‐122   8
  • 9. 13-­‐08-­‐12   InfecIon  control     -­‐  how  can  we   make  it  sIck  ?  Patient involvement: … they cannot and should not be responsible for their own safety in an environment over which they have no control v George Annas NEJM 354;19:2063-2066•  Because of the complexity of the process of change, it is not surprising that single intervention often fail …•  … a multimodal approach is necessary 9
  • 10. 13-­‐08-­‐12   Single  control   ConInious  control   Surveiilance   RegistraIon       MRSA       CWZ   Nijmegen   Online  feedback  of  rates  hhp://i-­‐prevent.blogspot.com/   10
  • 11. 13-­‐08-­‐12   You  need  to  learn  more   about  behavioral  science! •  Behavioral science –  Change of behavior •  Communication skills –  Convince –  Motivate –  Problem solving•  “Expensive = good” (and opposite)•  “If an expert said so, it must be true” •  Perceptual contrast –  Airline industry “captainitis” –  Buying suite and sweater à expensive item first•  “Because” –  Selling the car first, than the options –  Increase compliance even if no reasoning follows (example cutting lines) –  Possibly based on “because” … “just because” of parents when answering their childrens questions Shortcuts-­‐  contrast  -­‐  consistency   11
  • 12. 13-­‐08-­‐12  •  Most people have a strong desire to look consistent within their words, beliefs, attitudes•  Whenever one takes a stand that is visible to others, there arises a drive to maintain that stand in order to look like a consistent person.•  Therefore, written-down and publicly made commitments can be used to influence others and ourselves•  Question to home owners – place large billboard •  “We view behavior as correct to the degree we “Drive Carefully” in your lawn see other performing it” –  When lots of people do it – it must be right•  Two groups: A) 17% complied B) 76% complied •  Others laugh = it must be funny à we react to the sound – not the content•  Why the difference between A + B ? à works even if the sound is artificial (laugh-tracks) B was asked a few weeks before to display a small 3x3in sign in window “Be a safe driver”•  “ We most prefer to say YES to the request of •  Occurs when a one positive people we know and like” characteristic of a person dominates the way a person is viewed•  Factors leading to liking: –  Good-looking = talent, kind, honest, –  physical attractiveness (halo effect) intelligent –  similarity –  Works in many situations: even judicial –  familiarity process –  praise à handsome men lighter sentences –  association Works  the  other  way    around,  too!   12
  • 13. 13-­‐08-­‐12   Compliments  •  “We like people that are similar to us” –  more likely to help those that dress like us •  “We are phenomenal suckers for flattery” –  Positive comments produce just as much liking for the flatterer independent if they were untrue or true Familiarity   •  “Teamspirit” –  Car salesperson battling with his boss to give us•  “Increases through repeated contact under a good price –  Good Cop/Bad Cop positive circumstances”•  SALE •  An innocent association with –  Buying becomes more likely because it is either bad or good things will associated with good experience in the past influence how people feel about us or a product –  The good looking models next to•  Celebrities and advertisement the car –  Establish a connection; it doesn’t have to be •  Rating of identical car changed with a logical one, just a positive one and without model •  Men didn’t believe that their judgment was influenced 13

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