Reinforcement—from collaborative participants and happy residents—ensured the success of this nursing home’s infection control project

Through her participation in a regional “mini collaborative” focused on infection control and sponsored by Qualis Health and the Washington Department of Health, Kathy Burrer, the Administrator at Dungeness Courte Alzheimer’s Community (located in Sequim, WA) renewed her motivation to make handwashing a priority. The structure and educational sessions of the collaborative helped her turn that motivation into a successfully implemented project—even with a few bumps in the road.

As a group, the collaborative participants agreed that resident handwashing before meals was a manageable first improvement project. The Dungeness team decided to install an automatic hand sanitizer dispenser in the dining room. “We thought: oh, this will be easy,” Burrer laughed. “And then we slept on it and came to our senses. A wall-mounted, automatic dispenser with dementia patients? It just wouldn’t have worked here!”

The Dungeness team thought of several other approaches, but later decided that many weren’t practical and others received too much negative feedback from the caregivers to even attempt. Being part of the regional collaborative allowed Burrer to learn what other facilities were trying—which gave her more ideas and provided examples of how other organizations were able to get projects off the ground even though they also struggled with competing demands and less-than-perfect support from staff members.

Burrer realized that her biggest stumbling block was staff’s belief that the project wasn’t worthwhile. “They basically said, ‘We’re not doing it now. Why is it so important?’” Burrer reported.

She was able to use the collaborative’s training resources to demonstrate just how crucial handwashing is to control the spread of germs. She also pulled from her own experience as a caregiver and explained how the handwashing would ultimately make their jobs easier—a little time spent washing hands meant a lot less time caring for ill residents. “They realized that they didn’t have a choice,” Burrer explained. “If they didn’t do [the mealtime handwashing], they understood that they were putting the resident in harm’s way.”

The Dungeness team committed to a very simple approach. A little bucket, filled with warm water and wash cloths, is put in the dining room before lunch and dinner. Caregivers ensure that every resident gets a warm cloth to clean his or her hands and face. “It’s like being in first-class on an airplane,” Burrer said. “The residents told us how good it feels to have something nice and warm on their skin.”

And the caregivers who are responsible for the mealtime handwashing? “They realized it wasn’t that hard,” Burrer said. “They enjoy doing it because they see how much the residents like it.”

Burrer credits the collaborative for helping her break challenges down into small, workable pieces. “As much as we all know that, it helps to be reminded,” she admitted. “We all have a tendency to get disheartened and give up when something doesn’t work. It’s just one little piece; it doesn’t mean the whole thing failed! [The collaborative] helped us step back, look again, and say ‘OK, what else can we try?’”

A recent pneumonia outbreak in the community points to the effectiveness of the program. While a few Dungeness residents did become ill, the disease did not spread throughout the building. And, unlike other nearby facilities, they did not lose a single resident to the outbreak.