Hand hygiene is our top priority and the number one intervention to prevent healthcare-associated infections and transmission of organisms and diseases.  At the Johns Hopkins Hospital, we perform surveillance for hand hygiene compliance using a “secret shopper” methodology.  Unknown observers monitor hand hygiene practices on all of our units using standardized definitions and data collection procedures.  There is also a direct feedback program with known monitors who address, educate, and take the name of staff at the moment that they are observed not appropriately performing hand hygiene.  We monitor hand hygiene compliance upon each entry to and exit from a patient care room or area.  Click here to view the JHH Hand Hygiene policy.

Watch the Anatomical Surgical Hand Scrub video

Tools and Resources

• Hand Hygiene Training
• Hand Hygiene Toolkit
• Unit/Service Leader Checklist to Improve Hand Hygiene
• Hand Hygiene Fact Sheet
• JHH Hand Hygiene Compliance Data Collection Form
• JHH Hand Hygiene Detailed Activities Monitoring Tool
• HICPAC Guidelines for Hand Hygiene in Healthcare Settings, Published 2002
• Hand Hygiene Unit Activity Ideas

Posters and Signs

• Hand Hygiene -- How's Your Technique (I)
• Hand Hygiene -- How's Your Technique (II)
• When to Clean Hands
• How to Clean Hands
• Five Moments for Hand Hygiene
• This is Your Hand Unwashed
• Hand washing reminder sign
• JHH Hand Hygiene Poster #1
• JHH Hand Hygiene Poster #2
• JHH Hand Hygiene Poster #3

At the Johns Hopkins Hospital, we perform surveillance for CLABSI on all of our hospital units, including both intensive care unit (ICU) and non-ICU settings.  We utilize surveillance definitions from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).  CLABSI rates are expressed as the number of infections per 1000 central-line days. We provide weekly feedback of CLABSI data to all units along with their “Weeks Since Last CLABSI” data.  A comprehensive CLABSI prevention program includes unit-based root cause analysis of each infection and programs to promote, monitor and sustain evidence-based best practices for central line insertion and maintenance.  Click here to view the JHH Vascular Access Device policy.

Tools and Resources

• CLABSI Prevention Evidence-based Best Practices
• Central Line Insertion and Maintenance Best Practices
• Central Line Insertion Checklist
• SHEA-IDSA Compendium of Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals
• HICPAC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011
• HICPAC Checklist for Prevention of Central Line Associated BSI

Posters and Signs

• Weeks Since Last CLABSI Unit Display Wheel

At the Johns Hopkins Hospital, we perform surveillance for healthcare-associated transmission of C. difficile on all hospital units. Healthcare-associated transmission of C. difficile is defined as a positive test for the organism in the setting of diarrheal disease and a clinical picture consistent with C. difficile disease >48 hours after hospital admission if the condition did not appear to be present upon hospital or unit admission.  C. difficile healthcare-associated transmission rates are expressed as the number of C. difficile transmissions per 10,000 patient days.  Our C. difficile transmission prevention program includes hand hygiene promotion, antimicrobial stewardship, isolation precautions, environmental cleaning and disinfection, and programs to promote, monitor and sustain evidence-based best practices for MDRO prevention. 

Tools and Resources

• JHH Hand Hygiene Policy
• JHH Isolation Policy
• HICPAC Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006
• SHEA-IDSA Compendium of Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals
• HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

At the Johns Hopkins Hospital, we perform SSI surveillance for coronary artery bypass graft (CABG), Cesarean section (C-section), craniotomy, laminectomy, hip replacement, knee replacement, adult spinal fusion, and pediatric spinal fusion procedures.  We utilize surveillance definitions from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).  The National Surgical Quality Improvement Program (NSQIP) methodology is used to perform SSI surveillance following colon surgery.  SSI rates are expressed as the number of infections per 100 procedures for each type of surgery. A comprehensive SSI prevention program includes root cause analysis of each infection and programs to promote, monitor and sustain evidence-based best practices for SSI prevention. 

Tools and Resources

• Summary of Evidence-based Best Practices for SSI Prevention
• OR Attire and Procedures Audit Tool
• SHEA-IDSA Compendium of Strategies to Prevent Surgical Site Infections in Acute Care Hospitals
• HICPAC Guideline for the Prevention of Surgical Site Infection
• The Joint Commission- Information on the Surgical Care Improvement Project

Presentations

• Evidence-based Best Practices for SSI Prevention

At the Johns Hopkins Hospital, we perform VAP surveillance in all of our intensive care units (ICUs).  We utilize surveillance definitions from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).  Surveillance began in January 2011 for the NCCU and in July 2011 for all other ICUs.  VAP rates are expressed as the number of infections per 1000 ventilator-days.  A comprehensive VAP prevention program includes root cause analysis of each infection and programs to promote, monitor and sustain evidence-based best practices for VAP prevention. 

Tools and Resources

• Summary of Evidence-based Best Practices for VAP Prevention 
• VAP Prevention Audit Tool
• SHEA-IDSA Compendium of Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals
• HICPAC Guidelines for Preventing Healthcare-Associated Pneumonia, 2003

Presentations

• Evidence-based Best Practices for VAP Prevention

Posters and Signs

• Unit-based VAP Poster

At the Johns Hopkins Hospital, we perform CAUTI surveillance in all of our adult intensive care units (ICUs).  We utilize surveillance definitions from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).  Surveillance began in July 2011.  CAUTI rates are expressed as the number of infections per 1000 urinary catheter-days.  Our CAUTI prevention program is currently being implemented and includes efforts and programs to reduce the number of urinary catheter days by prompting catheter removal, improve urine sample collection procedures for urine cultures, and monitor and sustain evidence-based best practices for urinary catheter insertion and maintenance.

Tools and Resources

• Evidence-based best practices for CAUTI Prevention
• Podcast about CAUTI Prevention
• SHEA-IDSA Compendium of Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals
• HICPAC Guideline for Prevention of Catheter-Associated Urinary Tract Infections, 2009
• CAUTI Guideline Fast Facts

At the Johns Hopkins Hospital, we perform surveillance for healthcare-associated transmission of MRSA.  The ICUs and other high-risk units perform MRSA nasal surveillance cultures upon patient admission to the unit and weekly thereafter.  Healthcare-associated transmission of MRSA is defined as definite if the unit admission culture is negative and a subsequent clinical or surveillance culture grows MRSA >48 hours after unit admission.  Healthcare-associated transmission is defined as possible, but not definite, if there an admission surveillance culture is not performed and a subsequent clinical or surveillance culture grows MRSA >48 hours after unit admission.    MRSA healthcare-associated transmission rates are expressed as the number of MRSA transmissions per 1000 patient days.  Our MRSA transmission prevention program includes hand hygiene promotion, surveillance cultures on high-risk units, isolation precautions, environmental cleaning and disinfection, and programs to promote, monitor and sustain evidence-based best practices for MDRO prevention. 

Tools and Resources

• JHH Hand Hygiene Policy
• JHH Isolation Policy
• SHEA-IDSA Compendium of Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals
• HICPAC Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006
• HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

At the Johns Hopkins Hospital, we perform surveillance for healthcare-associated transmission of VRE.  The ICUs and other high-risk units perform VRE peri-rectal surveillance cultures upon patient admission to the unit and weekly thereafter.  Healthcare-associated transmission of VRE is defined as definite if the unit admission culture is negative and a subsequent clinical or surveillance culture grows VRE >48 hours after unit admission.  Healthcare-associated transmission is defined as possible, but not definite, if there an admission surveillance culture is not performed and a subsequent clinical or surveillance culture grows VRE >48 hours after unit admission.    VRE healthcare-associated transmission rates are expressed as the number of VRE transmissions per 1000 patient days.  Our VRE transmission prevention program includes hand hygiene promotion, surveillance cultures on high-risk units, isolation precautions, environmental cleaning and disinfection, and programs to promote, monitor and sustain evidence-based best practices for MDRO prevention. 

Tools and Resources

• JHH Hand Hygiene Policy
• JHH Isolation Policy
• HICPAC Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006
• HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

Multidrug-resistant Gram negative bacilli (MDR-GNB) are increasingly problematic in healthcare settings, primarily because of the paucity of effective antimicrobial agents that are available to treat infections with these organisms. Our MDR-GNB transmission prevention program includes hand hygiene promotion, antimicrobial stewardship, isolation precautions, environmental cleaning and disinfection, and programs to promote, monitor and sustain evidence-based best practices for Multidrug-Resistant Organism (MDRO) prevention. 

Tools and Resources

• JHH Hand Hygiene Policy
• JHH Isolation Policy
• HICPAC Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006
• HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
• CDC Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities
• CDC Laboratory Detection of Imipenem or Meropenem Resistance In Gram Negative Organisms

At the Johns Hopkins Hospital, we perform surveillance for influenza and respiratory syncytial virus (RSV) in all of our hospital inpatient and outpatient areas.  Influenza and RSV data are reported as the number of laboratory confirmed positive tests per week of surveillance. Healthcare-associated cases are also tracked and investigated.  A comprehensive respiratory virus prevention program includes hand hygiene promotion, healthcare personnel vaccination for influenza, education and reinforcement of respiratory etiquette, and programs to promote, monitor and sustain evidence-based best practices for respiratory virus prevention.  Click here for access to the JHH Respiratory Virus Prevention and Control policy.

Latest Data

• Sources of Influenza Virus activity
  • Maryland Data - Department of Health and Mental Hygiene FluWatch
  • US Data - Centers for Disease Control and Prevention FluView

Tools and Resources

• Information for Employees
  • JHH Influenza Vaccination Information for Employees
  • Employee Symptom Diary
• Obtaining a Laboratory Specimen
  • NP Flocked Swab Collection Video-Adult
  • NP Flocked Swab Collection Video-Pediatrics
  • NP Swab Collection Animation
• Treatment, Prophylaxis & Vaccination Guidelines
  • Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
  • CDC Seasonal Influenza Vaccination Information
  • CDC Influenza Antiviral Drug Information
• Information for Patients, Parents & Visitors
  • Adult Inpatient: Patient and Visitor Handout
  • Adult Inpatient: Patient and Visitor Handout in Spanish
  • Pediatric Inpatient: Parent and Visitor Handout
  • Pediatric Inpatient: Parent and Visitor Handout in Spanish
  • Pediatric Inpatient: Letter to Parents
  • Pediatric Inpatient: Letter to Parents in Spanish
• General Influenza Information
  • Centers for Disease Control and Prevention Influenza Website
  • FLU.gov

Posters and Signs

• Visitation Precautions
• Cover Your Cough Poster

The Johns Hopkins Hospital has joined the National Foundation for Infectious Disease's "Leading by Example" initiative to prevent influenza. More information is available at www.nfid.org.