Infection Control

IC discipline: Successfully approaching violators

Briefings on Infection Control, January 1, 2010

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Unless they work in a medical facility with perfectly compliant employees, IPs are usually forced into the unenviable but inevitable job of confronting a healthcare worker who is not adhering to safety regulations.
On most occasions, IPs encounter an innocent mistake or a one-time offense that is easily correctable. On other occasions, persistent or especially hardheaded employees will demonstrate consistent noncompliance because of inconvenience or simply out of sheer stubbornness.
In either case, IPs must be prepared to approach employees in an appropriate way that is beneficial to the safety of the healthcare worker and the overall adherence to IC and OSHA regulations and best practices within the facility.
Finding the right approach can often be challenging both in smaller private medical practices and in larger hospital systems.
With Joint Commission standards focusing on topics such as hand hygiene improvement, it’s imperative that IPs have a documented disciplinary policy along with an effective approach for fixing noncompliance issues.

Common violations
Two of the most common IC and safety violations are phlebotomists biting the tip of the index finger off of gloves to feel for a vein, and physicians not wearing required personal protective equipment (PPE) during procedures, says Kathy Rooker, safety officer and owner of Columbus Healthcare & Safety Consultants in Canal Winchester, OH. Incision and draining procedures are the most common vehicles for ignoring PPE because physicians don’t think they need the required gloves, mask, goggles, and impervious gown for such a simple procedure.
However, Rooker has seen instances in which pus has sprayed into a doctor’s mouth or eyes.
“I just try to tell them what the consequences are if they don’t wear it, and is it really worth them taking the risk?” Rooker says. “I hear, ‘Oh, I’m going to look ridiculous,’ and I say, ‘Yeah, but you’ll be alive.’ ”
Although all OSHA regulations are important from a general safety perspective, IPs should consider the risks involved with noncompliance, rather than how flagrant the foul is, says Steve MacArthur, a safety consultant at The Greeley Company in Marblehead, MA.
“For instance, at the moment, hand washing and wearing appropriate PPE have shifted as a function of their risk potential into the realm of probability,” MacArthur says.
“Now there is a very real threat as opposed to what might nominally be described as theoretical threat, so the tolerance levels for noncompliance, either accidental or purposeful, are much less because inappropriate protection can impact any number of people.”

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