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1 5 9 J U N E 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E INFECTION PREVENTION problems and seek out solutions on their own, but in most situations that doesn't happen. It's important for leadership to be very clear about what they're expecting. Once leadership was in the loop and fully engaged, they made it clear to the providers that they considered infections in general, and this bacteria in particular, a problem — and that they expected behavioral changes and interventions that would appropriately address it. Will they open the e-mails? Of course, when I started sending the e-mails, there was no guarantee that people would read them. So getting right to the point was impor- tant. I started each with the number of infections that had developed since the previous update and the number of new cases in each unit. The fact that we were comparing findings in different units was a strong motivator for people to look at the e-mail. I also included maps of the units, illustrating where we'd found the bacteria. One of the problems with bacteria is that they can't be seen. The maps made the issue less abstract and more tangible. Over time, we began to discern and discuss other issues. Shared objects, for example. It's very common for nurses to carry scissors around with them to open bandages. That needed to stop, because the bandages and the body surfaces the scissors touched were contami- nating the scissors. We addressed one thing at a time, depending on the findings from the previous week. The next week it might have been terminal clean- ing, or something having to do with another type of equipment. Some weeks we just included reminders — that wearing gloves doesn't eliminate the need for hand hygiene, for example. The improvement didn't happen overnight, but we finally begin to win the war: Over a 2-year period, the incidence of new cases OS_1406_part3_Layout 1 6/13/14 11:56 AM Page 159