Erica Susky and Brittany Jenkins
Infection Control Practitioner Erica Susky (L) and Brittany Jenkins, Toronto Western Hospital Emergency Department Advanced Practice Nurse Educator, teamed up to create fun, engaging activities for staff to reinforce training on how to protect patients and colleagues from C. difficile. (Photo: UHN)

How do you teach something most people not only already know, but also make it engaging and fun?

This is what Brittany Jenkins, Advanced Practice Nurse Educator (APNE) in the Emergency Department (ED) at Toronto Western Hospital, asked herself while looking for ways to implement Caring Safely's Hospital Acquired Conditions (HAC) prevention bundle for Clostridium difficile (C. diff) – a highly contagious bacterial infection that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.

"The ED is first line of defence against C. diff," Brittany explains. "We need to ensure cases are identified and isolated right away to keep staff safe, prevent it from spreading to visitors, patients, surfaces etc., and also make sure it gets flagged in the electronic patient record (EPR) so that the patient gets the appropriate bed when moved to an in-patient unit."

When it comes to stopping the spread of infection, proper hand hygiene is the most effective. This is no different for C. diff.

"It was a bit of a challenge to come up with an education plan that would engage staff," Brittany recalls. "Staff know what C. diff is, they know about hand hygiene – they've all learned about these things at different times in their careers.

"I didn't want to take the HAC bundle material and talk at them about it. I wanted to develop an interactive component for adult learners that would address any knowledge gaps and make the learning hands on."

Designed three, five-minute activities

HAC prevention bundles, which address six different conditions, are being rolled out across UHN in in-patient areas to reduce preventable harm.

Brittany partnered with TW Infection Control Practitioner, Erica Susky, who works with the hospital's ED and Critical Care teams to improve infection control practices.

Using the information from the HAC C. diff bundle, Brittany and Erica designed three, five-minute activities to:

  • help staff properly identify stool that should be sent for C. diff testing
  • show how easily bacteria can spread, and
  • underline the importance of hand hygiene

C. diff symptoms can often be mistaken for a number of other conditions, but one way to recognize it is through the consistency of a patient's stool. If a patient describes their stool in a way that is suspect of C. diff, it needs to be sent to a lab for analysis as soon as possible.

With the help of dollar store chocolate, Brittany and Erica created a life-like representation of the stool chart clinicians use in patient documentation and turned it into a game.

"We asked staff to look at the five different types of stool and identify which ones gave them concern, what actions they would take when encountering them and then we'd talk about it as a group," Brittany says. "This format allowed us to establish what knowledge-base staff were working with and then address any gaps."

And for those who could stomach it, there was a parting gift of chocolate treats.

C.diff stool chart
Using chocolate, Erica and Brittany created a life-like representation of the stool chart clinicians use in patient documentation and turned it into a game – asking staff to ask to identify the stool that should be sent for C. diff testing. (Photo: Brittany Jenkins)​

Aside from the stool test, two other activities were developed to underline to staff how easy it is to spread bacteria.

"We looked for a way to remind people that washing your hands is the number one way to prevent the spread of infections," Brittany says. "But bacteria isn't visible, so we needed an activity where they'd see it for themselves."

That activity involved asking staff to apply and remove Personal Protective Equipment (PPE), garments and equipment made to protect someone wearing it from infection.

The twist? After putting on PPE, Brittany or Erica would smear pudding on it and ask the staff person to remove the PPE without getting pudding on themselves.

"We placed pudding where you'd expect to get the most germs: on gloves, the gown and its sleeves," Erica recounts. "While trying to remove the PPE, we'd guide staff to the right technique but, inevitably, they'd get pudding on their wrist or elsewhere.

"It was eye opening for staff to see how much bacteria they really get on themselves while highlighting how important it is to thoroughly wash hands once PPE is removed."

Finally, Brittany and Erica designed one last activity to again highlight the importance of hand hygiene since gloves are not as invincible as a barrier as you would think.

Shared at 2019 Caring Safely Symposium

Using glow germ powder, staff were asked to put on a pair of gloves, rub the powder all over their gloved hands, and then remove the gloves. Brittany and Erica then shone a black light on everyone's hands.

"It was a shock for everyone to learn how porous the gloves were and that some particles had seeped through despite the gloves still being intact," Erica says. "Again it showed the importance of washing one's hands and that gloves are really a complement, not a substitute, for hand-washing."

Over a few weeks last summer, many of the TW ED staff – including housekeeping, ward clerks and even a security guard – participated in all three activities. Erica and Brittany would announce at the unit's morning Safety Huddle that their mobile station would be around in the afternoon for staff to drop by when they had a few minutes to spare during their shift.

The activities were a great success.

"Our staff really appreciated the treats and activities as well as the interactive components that made for a fun few minutes," Brittany says.

A C. diff info board and binder with the HAC bundle information were also set up for staff to consult whenever they wanted.

Thanks to the activities' success, Brittany and Erica were invited to share their work with other hospitals at the 2019 Caring Safely Symposium organized in February by UHN and the Hospital for Sick Children.

"Instead of talking to them about what we did, we actually went through all the activities with the forum attendees too," Brittany says. "It's great to be able to educate people in a way that is interesting and connects them to content in a way that is helpful."​

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