Hand Hygiene: The Foundation of Infection Prevention

Podcast Transcript

Carol Pehotsky (00:04):

Wash your Hands. Sounds So simple. Something we've heard since we were kids and Something we all doubled down on during the pandemic, and yet it is still the most common Source of transmission healthcare. I'm joined today by Chris Rose and Persis Sosiak from Infectious Prevention to talk more about why hand hygiene is So important and what we can all be doing from our own practice to speaking up to improve.

(00:32):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough on the job issues. We're So glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

(00:53):

Infection prevention has always been an important cornerstone of nursing. Well, frankly, going all the way back to Nightingale, right? And never was it really more important and in our face than the pandemic. But here we are in, I guess you could call it a post-pandemic world or whatever iteration that is. And yet, throughout all of time the cornerstones, how we protect ourselves and protect our patients always comes back to the basics. Something as simple as clean hands used to deliver the care of our patients.

(01:23):

We can add on things to it. There's all Sorts of other things we can and should be doing. Sometimes we lose sight of the basics of clean hands. And while that may seem simple to our listening audience, it is not simple and let's face it folks, we're not at 100% compliant in healthcare (laughs) So there's still work to be done.

(01:42):

And to that end, it's my great pleasure to welcome two guests to the show today. So, it's my great pleasure to welcome Chris Rose and Persis Sosiak. They are both infection preventionists, and Persis is also the Infection Prevention manager for the west submarket hospitals of the Cleveland Clinic. Welcome ladies. So glad to have you.

Persis Sosiak (01:59):

Thank you, Carol.

Chris Rose (02:00):

Thank you. Glad to be here.

Carol Pehotsky (02:01):

So, yes. So, they both just educated me that in our organization you do not have to be a nurse to be infection preventionist, but they're both nurses. So, I'm hoping each of you will give us a little bit of, of background of your nursing career and what drew you into the infection prevention space. Chris, I'm hoping I can pick on you first.

Chris Rose (02:18):

You sure can. Thank you. So, to be a nurse has been a blessing and all the opportunities to grow in different areas for all of us is just amazing. And so, I started my career as a bedside orthopedic nurse and did that for almost two decades. And then I floated in med-surg for a while, and then that led me to nursing education, which was amazing to help train new nurses and HUCs and do competency training and things of that nature, which then led me to infection prevention.

Carol Pehotsky (02:55):

Hmm.

Chris Rose (02:56):

So, I got invited, if you will, to look at an opportunity, and I've never looked back. So, I've been doing it for a little over 16 years.

Carol Pehotsky (03:07):

Wow. And boy, no shortage of opportunity to educate caregivers in that space. So, all fit together really nicely. (laughs)

Chris Rose (03:13):

It really did. Building blocks.

Carol Pehotsky (03:15):

For sure. Persis, how about you?

Persis Sosiak (03:18):

Carol, thank you. So, I started off my professional career at a non-governmental organization-

Carol Pehotsky (03:25):

Hmm.

Persis Sosiak (03:25):

... in Washington DC after I'd completed my master's degree in public health, upon which I was working on an infection control manual for Russian language speakers in countries overseas. Then, fast-forward a little bit, I went to nursing school thereafter and was here at Cleveland Clinic and happened to, if you will, bump into a very veteran infection preventionist who just gave me the heads-up that there was an opening.

(03:47):

So, I started it here at main campus, did that for a few years, did Some other things, went back to public health, and then four years ago, recently landed back here at Fairview and West Market.

Carol Pehotsky (03:58):

Wow. Well, welcome back. (laughs)

Persis Sosiak (04:00):

Thank you. Thank you. (laughs)

Carol Pehotsky (04:01):

You know, we could probably do a whole episode on that journey and-

Persis Sosiak (04:01):

Thanks.

Carol Pehotsky (04:05):

... I love it. Like it's always fascinating to me the roads that all of us journey on that, that brings us to the seats today. So, I, I know that each of you bring your full selves every (laughs) day to keeping our patients and our caregivers safe.

(04:17):

So, let's dive right in. We need proper hand hygiene. It seems So obvious, and yet as we know from all the literature, the hands remain the most common Source of transmission in healthcare. We know why it should be concerned, but how do we help get people to care about it? Persis, you're nodding very vigorously. You want to take this one? (laughs)

Persis Sosiak (04:37):

I agree with everything you said, and I think we realize that our caregivers are incredibly busy.

Carol Pehotsky (04:44):

Mm-hmm.

Persis Sosiak (04:44):

And they have a lot on their minds, and they are very laser-focused on the care of the patient and what that patient needs. And so, we hear a lot, "Oh, I forgot, or I had to run out of the room and run back in." And so, we fully believe that they're coming from the right place. But I think what we work on and strive to do is to maybe request a little pause or to kind of ask that they just take a moment, like a super-quick moment, but to just remember that anytime they enter that patient space, they could do any number of things for that patient, or they might have touched Something on the outside of the space.

(05:23):

And so that they really need to clean their hands, and we really need to, if you will, ingrain just the importance of cleaning your hands every time you enter the space and every time you exit it.

Chris Rose (05:34):

And with that, you know, it's important to hardwire these habits, right?

Carol Pehotsky (05:34):

Mm-hmm.

Chris Rose (05:39):

And so, if we hardwire it in the beginning and make it a habit, then you'll be doing it without thinking, you know, just like when you think about recyclable bags, right? And using them in the grocery store. I would give that example in my nursing education days.

(05:58):

I would say, "You know, when you're going to go to the store, grab that bag and then go in and use it." Well, the first time I went to the store, I forgot to grab the bag. So, I went back and got it. And then the next time I got partway through my experience, and I forgot the bag, (laughs) I made myself go get it.

(06:17):

Next time I was all the way to the checkout, didn't have my bag, said to the cashier, "I'm Sorry. I'll be right back." Now when I go to the store, I pull in my parking spot, pop the trunk, get my bags, and on I go.

(06:32):

So, if we as caregivers hardwire, and think about hand hygiene every day, every moment that, that, it's important, within a couple weeks, it'll be hardwired and you'll be doing it on the way in, on the way out. And then when you're in the space, you're thinking about, "Am I doing Something clean or am I doing Something dirty?"

Carol Pehotsky (06:32):

Oh, yeah.

Chris Rose (06:52):

So, if I'm going from a dirty task, then I need to clean my hands again before I go to the clean task. And so, I think just establishing those good habits early on really benefits us all.

Carol Pehotsky (07:05):

So, make sure we're all on the same page. Let's go over Some of the basics to make sure that everybody... (laughs) We can all agree on, on Some of the core tenets of hand hygiene. Let's go over when it's most critical and the steps required to have perfectly clean hands. Who wants to take that? Chris, do you want to start?

Chris Rose (07:20):

Sure. You know, we have the World Health Organization who gives us the five moments, right?

Carol Pehotsky (07:20):

Mm-hmm.

Chris Rose (07:25):

So, when we're thinking about the five moments, we want to make sure we have clean hands before we touch the patient, before we do a clean or aseptic technique, before we touch the patient's surroundings and before we put our gloves on. So, we just want to make sure that it's also after we've touched or been exposed to bodily fluids after touching the patient's environment.

Carol Pehotsky (07:25):

Mm-hmm.

Chris Rose (07:50):

So just thinking about what am I going to do next? And are my hands clean to do it?

Carol Pehotsky (07:56):

So, what did I just do and what am I going to do next?

Chris Rose (07:58):

Exactly.

Carol Pehotsky (07:58):

Yeah. I mean, can you over-clean your hands?

Chris Rose (08:04):

No. I don't, I don't know. (laughing) I don't think So.

Persis Sosiak (08:05):

(laughs) I have to say no.

Carol Pehotsky (08:06):

Well, and, and I think that I, I guess that's where I'm going with that, is that if you're not sure, clean your hands.

Persis Sosiak (08:10):

Right.

Carol Pehotsky (08:11):

Persis, can you talk us through alcohol-based cleaners versus Soap and water?

Persis Sosiak (08:15):

Yes. And that's Something that we do get asked about, and I think it's a really good question. So, there are times when Soap and water must be used. Those would include before we eat-

Carol Pehotsky (08:28):

Right.

Persis Sosiak (08:28):

... after we've used the bathroom. If our hands are visibly Soiled and if we're taking care of a patient, once we are done with that care if that patient has had C. difficile, also known as C. diff or norovirus Sort of situations where we know that the microorganisms can be spread via our hands.

Carol Pehotsky (08:29):

Okay.

Persis Sosiak (08:50):

So those really have to be Soap and water. And then for the rest of our, our day to day, our interactions with the patient, the care that we provide, that can be the alcohol-based hand rub, ABHR.

Carol Pehotsky (09:03):

And does a similar logic apply that if I always did Soap and water, that would also be okay?

Persis Sosiak (09:08):

Oh, that, (laughs) I think that I think that would be great.

Carol Pehotsky (09:11):

Yeah.

Persis Sosiak (09:11):

We just recognize, again, that timing doesn't permit. Sometimes the physical layout of the patient space doesn't permit. The sink might be a great distance away.

Carol Pehotsky (09:20):

Sure.

Persis Sosiak (09:20):

We hope that's not the case from our other hat around construction. But yes, it would be ideal. But we recognize that there is great value in the ABHR as well.

Carol Pehotsky (09:31):

Okay. Sometimes we hear people talk about, well, but I have gloves on.

Chris Rose (09:35):

Yes.

Carol Pehotsky (09:35):

Oh, we love that.

Chris Rose (09:36):

Oh, we love that. (laughs)

Carol Pehotsky (09:37):

Let's to talk about that.

Chris Rose (09:37):

Yeah.

Persis Sosiak (09:37):

Let's dive in there.

Chris Rose (09:38):

Right.

Carol Pehotsky (09:38):

Let's talk about that. Let's talk about that.

Persis Sosiak (09:39):

Chris, do you want to go first? (laughs)

Chris Rose (09:40):

Certainly will. Gloves, oh my goodness. Right? (laughs) Gloves are not a substitute for hand hygiene. Okay? And I feel badly that people feel like this is their end all be all protection. It's not. Your hand hygiene and your clean hands have to be your fail-safe. Because first of all, I always say imagine those gloves have microscopic holes in them, right? And they could very well have microscopic holes, and the microorganisms are smaller than those holes.

(10:10):

So, we always ask that gloves be used at the appropriate time because there is a place for that protection. But always remember that the foundation for infection prevention is your hand hygiene. And in your intro, I was thinking about, one of my favorite statements is hand hygiene is an elementary concept with a critical impact if you don't do it.

Carol Pehotsky (10:39):

Oh, boy. Yeah.

Chris Rose (10:40):

It's going to be on my tombstone. I'm just saying. (laughing)

Carol Pehotsky (10:43):

A long, long time from now. But, yes, I like it. I like it. (laughing)

Persis Sosiak (10:46):

Well, and if I could add-

Carol Pehotsky (10:47):

Please.

Persis Sosiak (10:48):

... to what Chris said, I think Something else that's really, really important is that we don't clean our gloves.

Chris Rose (10:48):

Yes.

Carol Pehotsky (10:48):

Ah.

Persis Sosiak (10:55):

I think we; we have both, um, probably-

Carol Pehotsky (10:57):

Despite what maybe you saw during the pandemic. (laughing)

Persis Sosiak (10:57):

Yes.

Carol Pehotsky (10:59):

Yes. Yes.

Persis Sosiak (10:59):

Or even afterwards, we don't foam our gloves. If you feel as though your gloves are dirty, you should remove them safely and appropriately, clean your hands and then put new gloves on.

Chris Rose (11:11):

Right. They're a single use item.

Persis Sosiak (11:13):

Yeah.

Chris Rose (11:14):

It is a single use item. (laughs)

Carol Pehotsky (11:16):

Yes. That, that, again, a separate episode perhaps, but yes, exactly. (laughs) So we've talked about Some other mistakes in terms of maybe I didn't clean at the right time, or I didn't use the appropriate product. What are Some other hand hygiene mistakes that you've seen in your travels that we need to avoid?

Persis Sosiak (11:33):

Well, I, I'd be happy to start on that. I think one is that, well, I wasn't going into touch the patient. I was just going into ask them a question, which I-

Carol Pehotsky (11:42):

Classic. (laughing).

Persis Sosiak (11:43):

Yeah. I could appreciate that. That might be your agenda as a caregiver. But then if we are observing that situation, as Soon as the caregiver goes in, goes bedside, hands go immediately to the rails. And-

Carol Pehotsky (11:43):

Ah.

Persis Sosiak (11:56):

... maybe they did not touch the patient, but they touched the patient's environment. So, for us, they did touch the patient, but their hands weren't clean, and we don't know where they were. And perhaps that patient might have also been on precautions, which we hope that caregiver went in in their appropriate PPE. But that I'm not going to touch the patient, that's Something we hear pretty regularly.

(12:17):

And if I could, if asked, well, could you just wash your hands? The response is not, "Well, I wasn't going to do anything." The response is, thank you and wash your hands. (laughing)

Carol Pehotsky (12:27):

Yes. Yes. Any other mistakes, Chris, that you see that we need to be cognizant of?

Chris Rose (12:31):

They may say, "Well, I already cleaned my hands. They weren't dirty." Right?

Carol Pehotsky (12:35):

Yeah.

Chris Rose (12:36):

And I mean, I love that where I was only going to ask them a question. I've even had them say, "Oh, I was just going to hand them a medication or hand them, you know, their menu or whatever." And so, to Persis' point-

Carol Pehotsky (12:49):

Yeah.

Chris Rose (12:49):

... as caregivers, we have our agenda going into the room. Right? (laughs) Once you cross that threshold, all bets are off, right?

Carol Pehotsky (12:50):

Yeah. (laughs).

Chris Rose (12:56):

Because the patient agenda's going to be different than ours. We don't know what's going to happen in that interaction that we're going to have to touch the patient or their environment.

Carol Pehotsky (13:06):

You want to be able to meet the patient's needs, not, "Oh, I'm Sorry. I'm not fully prepared to hand you that ice water because I didn't wash..." No. Go in prepared with clean hands.

(13:15):

So, the workplace setup obviously can set us up for success, or perhaps not when it comes to clean hands. What are Some things that either nurses or nursing leaders should be thinking about when it comes to setting ourselves up for success when it comes to hand hygiene?

Chris Rose (13:30):

Having the product at the right place for the workflow. So often we'll be consulted to come if there's a new construction or, you know, just if the compliance is down, you know, the nurse manager might want to know, how can we promote good hand hygiene?

(13:47):

Well, let's look at their workflow and what makes the most sense in this space. You know, I, I call [inaudible 00:13:54] those areas where you don't have Solid walls.

Carol Pehotsky (13:57):

Yeah. (laughs).

Chris Rose (13:57):

Right? And so that's led to having the product on the movable WOW. You know, and to have it close by. So just thinking about those things, you know, where is it best to have the product available to offer that success of being able to make it convenient? Because we want to make it convenient for our caregivers to do the right thing.

Carol Pehotsky (14:23):

Well, and coming from spaces where that's a lot of where my clinical practice was is where there, where there weren't walls. And so, yeah, having that conversation that says, "We tried Something and maybe that didn't work. If WOW isn't in the right place, where is the right place to put the alcohol-based cleaner So that it is within the workflow, it is within the natural path So it's almost harder not to get your hands clean because it's right there?"

Chris Rose (14:44):

So, for example, two behavioral health areas.

Carol Pehotsky (14:48):

Oh, yeah.

Chris Rose (14:48):

We can't have that, you know, mounted it will be utilized in an inappropriate way by the patients potentially. So oftentimes caregivers have the product on their person. You know, they have the mini hand sanitizer. And I, I laugh because there's this one security officer that works at our hospital on this one unit, and as Soon as he sees me, (laughs) he shows me his hand sanitizer.

(15:13):

And I said, "I see you're equipped with your ammunition for patient safety and you." So, you know, (laughs) it's just kind of fun.

Persis Sosiak (15:21):

I, I think in speaking about how our nursing leaders can be part of this, I think one, an opportunity is to model good behavior. And-

Carol Pehotsky (15:30):

Absolutely.

Persis Sosiak (15:31):

... I think that that can be very meaningful and impactful to other caregivers. I think another concept is really surrounding our culture of high reliability. That anyone in any role can politely and kindly say to anyone in any role, "Please wash your hands."

(15:52):

And at least at, at my facility, it's been very impressive to see that in practice. And again, when we are asked if we don't do it for whatever reason, the response should be, "Thank you." And-

Carol Pehotsky (16:04):

Yes.

Persis Sosiak (16:04):

... proceed to wash there. It's not an opportunity to argue or to push back or to degrade in any way. But I think that the high reliability concepts really have been powerful for things in infection prevention like hand hygiene.

Carol Pehotsky (16:18):

Yeah.

Persis Sosiak (16:19):

Like PPE.

Chris Rose (16:20):

And another point along those lines, if a patient or a visitor asks a caregiver to clean their hands, you may have done it on the way in and their head was turned or Something. Again, thank you for the reminder. I did clean my hands, but I'm going to do it again for you because I know this is important.

(16:41):

And when I worked in nursing education, I would say that cleaning your hands in front of a person that is a stranger to you and you're a stranger to them is a nonverbal indication of trust-

Carol Pehotsky (16:55):

Yeah.

Chris Rose (16:55):

... building because patients and visitors know that it's expected that we're going to clean our hands. And when you come in cleaning your hands, you've already made a good impression to that patient because they can trust you for doing that. So, I think that it just really speaks volumes.

Carol Pehotsky (17:14):

It's a sign of respect.

Chris Rose (17:16):

It is.

Carol Pehotsky (17:16):

Yeah. Absolutely.

Chris Rose (17:16):

It is.

Carol Pehotsky (17:17):

It's a way to build that trust. Yeah.

Chris Rose (17:18):

And patients, they don't feel comfortable. I mean, I have been in a situation as an infection, preventionist, this is my job, and then I'm in healthcare and Someone's not doing what they're supposed to. I start to get a little nervous about wanting to speak up, but of course I did.

(17:34):

And if I was nervous about it, you know, think how the patient feels. They're going to feel like, "Well, if I speak up then maybe they're not going to give me the best care, or they're going to be upset with me and, you know, there might be ramifications."

(17:48):

So, if we all just try to, you know, do it-

Carol Pehotsky (17:53):

Right.

Chris Rose (17:53):

... every time, and when we don't do it, be polite about the reminder.

Carol Pehotsky (17:59):

Well, and like we've mentioned, we're all human, right? So, in the spirit of no one's like, "I can't wait to use dirty hands on a patient." (laughing) It's [inaudible 00:18:08] we're, we're, we're going to assume that. Right?

(18:10):

And so, to your point around, it's uncomfortable to say to Somebody... We talk a lot about speaking up over the course of this show. So, I've known Chris for years, and so one of Chris's techniques in the past was this program called SNAP. So, I'm wondering if you can share a little bit more about this program, partially because it Sort of took away Some of the, the heat perhaps around speaking up to each other on hand hygiene.

Chris Rose (18:33):

Sure. Thank you. (laughs) Yeah. So SNAP is an acronym that stands for Scrub Now and Prevent.

Carol Pehotsky (18:40):

Mm-hmm.

Chris Rose (18:40):

And the, uh, great value in SNAP is that it is a word you can use in a sentence. "Oh, SNAP, I forgot to tell you Something. (laughs) When we get done here, let's, you know, chat, or, oh, SNAP, I forgot my lunch, darn it." Or the other thing is, you could respectfully snap your fingers to the side. And so that's just a visual cue of SNAP.

(19:05):

So, if two caregivers are going into a room and one forgets to clean their hands, and the other one recognizes that, they can use either the word SNAP in a sentence or they could politely snap their fingers to the side. And then that would be the cue to clean your hands. And the patients know wiser for the interaction, you know?

Carol Pehotsky (19:26):

Right. There's lots of ways to speak up and, and of course we want people to feel comfortable being open, but there are instances where, yeah, just, oh, right, right. And I go grab that phone.

Chris Rose (19:35):

Mm-hmm.

Carol Pehotsky (19:35):

Yeah.

Chris Rose (19:35):

And I, I have a great example from that. Years ago, there was a housekeeper that witnessed a physician in the intensive care unit who missed an opportunity. And so, she-

Carol Pehotsky (19:48):

Hmm.

Chris Rose (19:49):

... she kind of like snapped her fingers in a like very coy, polite way with a little smile. And he kind of looked at her strangely. And so, she did it again. And then he's like, "Oh, yes. Thank you for reminding me." And he went to the hand sanitizer.

(20:05):

And that was like my favorite story because that spoke to both her courage to use the tool and him being receptive to the reminder.

Carol Pehotsky (20:15):

So, we've spent a lot of time talking about getting our hands clean, but our hands interact with all Sorts of other things (laughing) that can also get really dirty. So, if we can transition to, oh, I don't know, keyboards, cell phones, other technologies that our hands have to interact with, but appreciating that Some of that technology is not set up to be easily cleaned.

(20:39):

How is a nurse supposed to know how to interact with those things, how to keep them clean, how to keep my hands clean?

Persis Sosiak (20:45):

So, a great question, and again, one posed to us regularly.

Carol Pehotsky (20:49):

Yeah.

Persis Sosiak (20:50):

So, for all caregivers, ourselves included, if we encounter Something that is dirty, we should make every attempt to clean it. So, if we know how we should go and get the appropriate cleaning agent and clean it. If we don't know how, that's where we can make a request of our management, our leaders, to ask for their assistance.

(21:09):

We also recognize that a lot of our equipment, as you've said, is incredibly specialized. And so, when we get into things like that, that's why we have the MIFUs-

Carol Pehotsky (21:09):

Mm-hmm.

Persis Sosiak (21:18):

... or the manufacturer's instructions for use, and we have one Source. And so, there's a lot of information out there about how we clean those. But I think for me, and I, I think for us collectively, what it boils down to is that if we see Something that is dirty or that we don't want to touch, we should make every attempt to clean it. And, and that's just a good way to kind of, you know, go about our day.

Carol Pehotsky (21:40):

Sure. It's probably safe to assume that all of our cell phones are pretty disgusting, and we should just go ahead and clean our hands after we touch them anyway. (laughing)

Chris Rose (21:48):

Yes.

Persis Sosiak (21:49):

Yes. There are wipes that you can use-

Carol Pehotsky (21:49):

Yes.

Persis Sosiak (21:52):

... for Some of the different technologies. So, I am thinking about Some of our neonatal intensive care units.

Chris Rose (21:52):

Oh, yeah.

Persis Sosiak (21:58):

When you enter into those units, they will have a dispenser of screen wipes-

Carol Pehotsky (22:03):

Oh.

Persis Sosiak (22:03):

... for anyone entering the unit, whether it's a caregiver or a family visitor. So, the products exist, and they go everywhere with us. (laughs) Right? So, I think that's a really great point.

Chris Rose (22:15):

Agreed. And just keeping in mind that you are the last touch between you and the patient, right? So, if you're giving a me- medication and you've been scanning and all that, you want to make sure that before you're actually giving the medication to the patient, your hands are clean. Right?

(22:33):

So, there's resources out there, and I know this is a global audience beyond the Cleveland Clinic, but within the Cleveland Clinic, and I'm sure at other hospitals alike-

Carol Pehotsky (22:45):

Okay.

Chris Rose (22:45):

... we have a playbook that provides information on scenarios and job roles and gives direction on the most often incidences that come up explaining how best to manage that procedure with hand hygiene. So, something to look into if you're part of the Cleveland Clinic. And if you're not, you can ask about that at your facility.

Carol Pehotsky (23:09):

That's right. You know, we mentioned earlier in the episode about audits. So, talk to us just a little bit about how would I know how my unit's doing? How do nurses get involved in making sure that nurses and everybody interacting in our unit is, is really living into good hand hygiene?

Chris Rose (23:28):

Well, within the enterprise, we have a hand hygiene dashboard that is fed from the observations that are conducted by the Ohio Hospital Association Observers.

Carol Pehotsky (23:40):

Hmm.

Chris Rose (23:40):

So, we actually have paid observers that come into our facilities-

Carol Pehotsky (23:44):

Hmm.

Chris Rose (23:44):

... and do X amount of observations each month. And they are targeted on the inpatient units, the emergency room, and then Some in the operative settings, depending upon your hospital. So oftentimes the infection preventionist at each of our local hospitals will disseminate that information on a monthly basis. But there's also the dashboard on the internet that they can go to look at that information and filter it down.

Persis Sosiak (24:13):

I think exactly what Chris said is a very significant way we do audits and observations, but I know that at, in a lot of settings, there will also be additional-

Carol Pehotsky (24:23):

Mm-hmm.

Persis Sosiak (24:23):

... audits conducted. It's maybe not then, if you will, the secret shopper, because it's people that you know and work with. But it's not unusual to have a hand hygiene champion on a unit or in an area. And then that individual might do their own set of audits or might then ask a colleague to say, "Oh, would you be the auditor for this month?" And those data don't get fed to the dashboard that Chris mentioned, but that is shared internally. So that can be another technique that is used.

Carol Pehotsky (24:53):

And, and what we always, we talk a lot in Nurse Central about shared governance. What a, what a great opportunity for nurses to get involved. How are we doing? And then reaching into the toolkit. Like you mentioned, to say, "Okay. We're not where we want to be, what..." There are resources out there. Let's connect those resources and make things better.

Persis Sosiak (25:08):

Mm-hmm.

Carol Pehotsky (25:09):

So, we, we've talked a little bit about the pandemic and the importance of all the things we, we did during that time. And, and to the degree that we are post-pandemic, (laughs) lots of tension, of course, paid at that time around hand hygiene and PPE. Are you seeing any of that sustain? Have we had Some drop-off, a dramatic drop-off for people Sort of fatigued?

[NEW_PARAGRAPH] I, I have my own personal opinions, (laughs) but I'm looking for your professional opinions in the travels that you're making.

Persis Sosiak (25:38):

So, I think that a lot has stuck.

Carol Pehotsky (25:40):

Yeah.

Persis Sosiak (25:40):

I think there is still a lot of very good practice when it comes to personal protective equipment, PPE.

Carol Pehotsky (25:46):

Okay.

Persis Sosiak (25:47):

I will say, though, I recognize the fatigue, and I think this time of year when we are in respiratory virus season, it can be really hard.

Carol Pehotsky (25:47):

Yeah.

Persis Sosiak (25:56):

And when we have to go and say, "Oh, no. You need a mask." It's hard. And that, that can be tough for caregivers. I think Some of the things we hear are, well, the patient's asymptomatic or they say they're feeling fine, or I mean, you know, you can imagine what, what we learn. But I can only hope though that the time that we were in when it was pandemic, that we can carry Some of it over. That, that type of personal protective equipment is important, and that we need that not only for our patients, but for ourselves-

Carol Pehotsky (25:56):

Mm-hmm.

Persis Sosiak (26:22):

... and then for whomever we go home to.

Chris Rose (26:25):

Right. And, you know, it really is changed since the pandemic, because before, if Someone had a mask in the hallway, you were telling them to take it off.

Persis Sosiak (26:25):

Yeah. Yeah. (laughs).

Chris Rose (26:34):

You know because this is not appropriate. Right? And now masks are permitted, and they are encouraged in the right spaces. Right? And what we feel is, first of all, you know, if everybody followed standard precautions, there really would be no need for transmission-based precautions. Because standard precautions are taking a look at the situation and the risk at hand and the risk to exposure, and then using the right personal protective equipment to protect yourself.

(27:05):

This is a COVID room. You have to have eyewear protection, and your glasses don't serve that purpose. You need to wear the gown. It has to be tied, things of that nature. And then we have, you know, other caregivers that are wearing a mask from the time they come into the hospital until they leave. And, and that's okay as long as we're, you know, wearing the mask appropriately, right. As it's intended, we're covering the nose and it's, you know, under the chin. And if it gets Soiled or if it's, if you go into a room that is a transmission-based precautions, you're changing that mask before you come out. You know, so utilizing it appropriately is important.

Carol Pehotsky (27:48):

Excellent.

Chris Rose (27:49):

Mm-hmm.

Carol Pehotsky (27:49):

Well, ladies, I cannot thank you enough for coming on the show today. Before we call it a day, we're going to flip to our speed round So that our audience can get to know a little bit more about you (laughs) as amazing human beings as well as fabulous content experts.

(28:02):

So, you give a lot to our organization and our caregivers and patients, but let's say it's finally time to unwind. (laughing) What are you doing for you to recharge? Persis, I'll pick on you first.

Persis Sosiak (28:13):

Oh, well, thank you. And I've appreciated this time that for us to be together and speak to this. So, I'm not going to reveal my age, (laughing) but I have taken ballet lessons, ballet class since I was three years old. So, I continue to take class. So, um, that's been a really great form of exercise-

Carol Pehotsky (28:32):

Yeah.

Persis Sosiak (28:32):

... and mental kind of release. And then if I'm not in the studio, I love to cook. I love to knit and read. And I have an almost two-year-old rescue dog. (laughs)

Carol Pehotsky (28:43):

Aw. Wonderful. Chris, how about you?

Chris Rose (28:45):

Well, within the last year, I started taking water aerobics.

Carol Pehotsky (28:49):

Ooh.

Chris Rose (28:49):

And that is a bit-

Carol Pehotsky (28:50):

That's tough.

Chris Rose (28:51):

It... Well, it is amazing. (laughs) And I'm not going to reveal my age either, (laughing) but three of my four joints, lower extremity joints are replaced. And it amazes me what I can do in the water that I cannot do outside of the water. And it is such a mental uplift.

Carol Pehotsky (29:09):

Mm-hmm.

Chris Rose (29:09):

Like if I can jump rope in the water-

Carol Pehotsky (29:11):

Hmm.

Chris Rose (29:12):

... I, I just... It's amazing.

Carol Pehotsky (29:14):

Awesome. (laughing).

Chris Rose (29:14):

I also enjoy bike riding and spending time with my six grandchildren.

Carol Pehotsky (29:19):

Wonderful. Ladies, thank you So much for joining us today.

Persis Sosiak (29:22):

Thank you.

Chris Rose (29:22):

Thank you for having us.

Carol Pehotsky (29:23):

As always, thanks So much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(30:01):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.