Situation:

Handwashing is one of the most effective ways to reduce the spread of bacteria and reduce the risk for infection. Patients are encouraged to ask their providers if they have used gel or washed their hands but many are often timid or shy about asking not wanting to question a provider.

Background:

On 15Llong it seems we have seen an increase in chorioamnionitis (infection of the membranes and fluid) surrounding the baby. Providers are performing vaginal exams and placing internal monitors as needed with an increased risk of introducing bacteria into the vagina. A chorio diagnosis almost always results in treating the mother with antibiotics, lab testing on the infant (CBC, blood cultures) and increased frequencies of vital signs (using nursing resources) and treating the infant with IV antibiotics in some cases.

Assessment:

Handwashing is not consistent among providers (largely MDs on our unit), even when asked if they washed or used gel on their hands. Gel and sinks are immediately available when they walk into the room but are often not utilized properly upon entering/exiting the room. When prompted the providers gladly comply with the handwashing request but should not have to be prompted.

Recommendation:

A surveillance project to encourage providers to wash/gel in the view of patient and/or nurse and documentation of what was done. A similar project was enacted at UC San Diego after high chorio rates were noted and found a large decrease in the amount of cases of chorio. A flowsheet kept at the bedside with the notes of the time of the vaginal exams, if the provider washed or used gel and the patient temperatures were recorded and can be reviewed in the cases of chorio. There needs to be a more consistent system to track the incidence and likely cause of chorio would could greatly reduce nursing resources, infant admission to ICN, use of antibiotics or unnecessary tests on infants, and even reduce the length of stay.