How an Irish nursing home embraced hand hygiene

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Jim Mann
Jim Mann

Our search for a nursing home that had control of their handwashing took us to Ireland. Tralee, Ireland to be more specific. We had heard about a nursing home's years of success in complimenting their observational handwash monitoring with electronics.

This non-denominational facility, Cúil Díden, was built in 2002 and 64 residents call it home. Most are single occupancy rooms. The facility is 100% occupied and enjoys a solid waiting list. It is located in a rural area near the Bay of Tralee. 

Cúil Díden translates to  “nook of shelter.” Catriona O'Connor, the proprietor and Director of Care, has created a very special nook of healing care, person-centered care.

Catriona is made for her job – a caring leader who knows how to get things done with an infectious enthusiasm affecting both care-receivers and givers. Happiness as well as healing are stated goals and can be measured by the dominance of smiling faces. A loving touch has created a better “product” which is at the core of the team's success and their waitlist.

Cúil Díden's standards of cleanliness includes work patterns where everyone cleans because everyone cares. The result is a sparkling clean home all can be proud of.  The air is neither fouled by the taint of medicinal-disinfectants nor incontinence.

Drilling down on handwashing practices at Cúil Díden, we witnessed the power of person-centered care. Initial interviews with new residents include a session on handwashing as a shared responsibility. “We care for you and ask you care for your fellow residents and the caregivers by actively washing your hands.”

This same day-one “training” is delivered to new employees as a condition of their employment and expected professionalism. Residents are informed of the electronic reminder system used by all Cúil Díden caregivers, assuring handwashes are not missed. They are advised to check the color of the caregiver's badge of caring and remind him or her whenever a red badge is seen.

The electronic supplement to observational monitoring started 6 years ago. The early days had some issues but were quickly resolved through the commitments of both the Cúil Díden team and the supplier, HygenX, an Irish manufacturer. Its success is in its simplicity, adapting the technology to current work practices rather than the reverse.

The system includes monitoring the all-important kitchen where staff-care touches residents at least three times per day. A norovirus infection in the kitchen can have a devastating effect on the immune-compromised residents as it travels from person-to-person and surface-to-person.

Asked how she took on the added cost of installing an Electronic Hand Hygiene  Monitoring System, O'Connor responded “It's all about priorities. I take the money from the less important programs. That's how we work.” At Cúil Díden it is simply a matter of prioritizing everything based on risk to the residents and replacing the less important factors. In the case of enhanced handwashing the lowering of nursing home infections pays for itself. It is hard to find anything more likely to reduce HAI's than better hand hygiene.

Cúil Díden's handwashing program has become a competitive advantage and source of pride for the caregiving team making staffing much easier. Everyone likes working for a winner.

Congratulations to Catriona and her team!

Jim Mann is the executive director for the Handwashing For Life® Institute

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