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Using Culture to Sustain Desirable Infection Prevention Behaviors · The SHEA Podcast

• 0:09
  SPEAKER_02: Welcome to the Social and Cultural Aspects of Infection Control and Antibiotic Stewardship Podcast Series, brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of health care associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:31
  SPEAKER_02: I am Dr.
• 0:32
  SPEAKER_02: Katherine Derber, a professor in infectious diseases at Eastern Virginia Medical School, and I will serve as today's moderator.
• 0:39
  SPEAKER_02: Shay is excited to launch this final episode of the social and cultural aspects of infection control and antibiotic stewardship series using culture to sustain desirable infection prevention behaviors.
• 0:52
  SPEAKER_02: In this episode, we will discuss some of the barriers that contribute to the decreased adherence to infection prevention guidelines and the implications they have with regard to patient safety.
• 1:03
  SPEAKER_02: In addition, speakers will talk about potential behavioral strategies that can be implemented to drive appropriate infection prevention practices.
• 1:12
  SPEAKER_02: I'm happy to introduce our speakers for today.
• 1:14
  SPEAKER_02: First, we have Dr.
• 1:15
  SPEAKER_02: Jennifer Hannahan, Chief of the Division of Infectious Diseases at the Eastern Virginia Medical School, as well as the EVMS Foundation Distinguished Professorship in Internal Medicine.
• 1:27
  SPEAKER_02: Dr.
• 1:28
  SPEAKER_02: Hannahan was previously the medical director for infection prevention at Prometica in Toledo, and prior to that at Metro Health Medical Center in Cleveland.
• 1:37
  SPEAKER_01: Hi, thank you very much for inviting me.
• 1:40
  SPEAKER_02: Next we have Dr.
• 1:41
  SPEAKER_02: Daniel Walker.
• 1:42
  SPEAKER_02: Dr.
• 1:42
  SPEAKER_02: Walker is the Vice Chair for Research and Associate Professor in the Department of Family and Community Medicine, as well as a member of Catalyst, the Center for the Advancement of Team Science, Analytics, and Systems Thinking, and the Ohio State University College of Medicine.
• 2:00
  SPEAKER_02: His research focuses on a wide range of health services, research topics, including health system efforts to address social determinants of health, such as food and security and digital equity, the exchange of health information across the care continuum, the implementation of patient-facing health information technology, and changes in delivery system configuration.
• 2:22
  SPEAKER_02: Dr.
• 2:22
  SPEAKER_02: Walker received his PhD in global health management and policy from Tulane University School of Public Health and Tropical Medicine, and his Master of Public Health in Health Management and Policy from Drexel University, Dormside School of Public Health.
• 2:37
  SPEAKER_00: Hello, it's a pleasure to be here.
• 2:38
  SPEAKER_02: Thank you both for joining us.
• 2:40
  SPEAKER_02: Let's jump in.
• 2:41
  SPEAKER_02: Our first question: what have been some of the most challenging infection prevention practices to enforce or change?
• 2:48
  SPEAKER_02: Jennifer, we'll start with you.
• 2:49
  SPEAKER_01: This is a great question.
• 2:51
  SPEAKER_01: And, you know, I could talk about this for hours, but I'll limit myself, obviously.
• 2:55
  SPEAKER_01: You know, we've had a lot of challenges in recent years with the advent of COVID.
• 2:59
  SPEAKER_01: People were making up their own infection prevention practices.
• 3:02
  SPEAKER_01: And so it's definitely been a challenge.
• 3:03
  SPEAKER_01: But I would say consistently, you know, during my entire career, the things that I've had the most difficulty with have been, you know, getting people to really follow contact isolation precautions and then also environmental cleaning in hospitals is really difficult.
• 3:18
  SPEAKER_01: So with contact isolation, it's hard to get people to recognize that this is something that really needs to be done consistently.
• 3:25
  SPEAKER_01: And what I mean by consistently is really every time they go in the patient room.
• 3:28
  SPEAKER_01: So people will think, oh, you know, I'm just going in to adjust this IV, or I'm not really going to be touching anything, not realizing that, of course, they are touching things.
• 3:37
  SPEAKER_01: Or, you know, they may go into a patient's room who's in contact isolation and there may not be the dedicated patient equipment, like there may not be a dedicated stethoscope in the room, and they end up using their own stethoscope and then they walk out and they don't disinfect it.
• 3:52
  SPEAKER_01: So they don't necessarily recognize that they may be causing harm to the next patient that they examine.
• 3:59
  SPEAKER_01: And then the second problem that we have is cleaning.
• 4:02
  SPEAKER_01: You know, first of all, many items that are used for patient care are just not designed to be easy to clean.
• 4:08
  SPEAKER_01: It's been a mystery to me how the companies come up with some of these things, but you know, they have a lot of crevices and areas where body fluids get trapped and dried on, and they're just really difficult to clean.
• 4:19
  SPEAKER_01: And, you know, one of the things that I've seen is that sometimes there's items that are in patient rooms where no one can really say for sure who's responsible for cleaning it.
• 4:28
  SPEAKER_01: And so when you have that situation, that means it's not getting cleaned, at least not consistently.
• 4:34
  SPEAKER_01: And so that is one really big area of focus, I think, for infection prevention.
• 4:40
  SPEAKER_01: So I would say getting people to follow the isolation precautions that we put in place and then figuring out how to make sure that things are being cleaned.
• 4:47
  SPEAKER_01: Dan, any other thoughts?
• 4:49
  SPEAKER_00: Yeah, I mean, I wholeheartedly agree that this is really an excellent question.
• 4:53
  SPEAKER_00: And I want to start by just saying that so my perspective is really different in that I come from kind of the management uh sciences and organizational sciences.
• 5:03
  SPEAKER_00: So I see infection prevention through that lens, and I think a lot about kind of structures and systems that can be put in place to create that enforcement and to take it off kind of any individual.
• 5:13
  SPEAKER_00: With that said, I think it's not really any one practice specifically, but rather the context of how a specific practice might be implemented.
• 5:22
  SPEAKER_00: So what I mean by that is any infection practice, no matter how effective it might be, needs to be implemented with appropriate support.
• 5:30
  SPEAKER_00: It really needs leadership support, peer support, education, possibly technology or other resources or tools, and it really just can't exist in a vacuum.
• 5:38
  SPEAKER_00: And I think when you look at the literature broadly of the infection prevention practices that are difficult to change, it's ones where care team members are entrenched in a specific way of doing things, unopened to change and evidence, and not supported in making those changes.
• 5:52
  SPEAKER_00: So I'll give you an example.
• 5:53
  SPEAKER_00: One of the best approaches to reducing catheter associated to urinary tract infection or cowdies is to empower nurses to remove indwelling catheters through a nurse-led protocol.
• 6:02
  SPEAKER_00: However, these nurse-driven protocols are really inconsistently used.
• 6:06
  SPEAKER_00: We did a study where we interviewed nearly 450 nurses and physicians at 18 hospitals across the country about this practice, and what we found was what helped nurse-driven protocol be used consistently was four things.
• 6:18
  SPEAKER_00: The first is training care team members, discussing the catheter appropriateness and nurses' perspective during rounds, reminding care team members to follow the nurse-driven protocol, and developing buy-in for the nurse-driven protocol use across the hospital.
• 6:32
  SPEAKER_00: The point really being that it can't just be something that exists on paper, but to really enforce these things and to encourage them, it needs to be supported in myriad ways.
• 6:41
  SPEAKER_00: And I think that this is true across infection prevention practices.
• 6:44
  SPEAKER_02: Thank you, Dan.
• 6:45
  SPEAKER_02: Those are some really important points.
• 6:47
  SPEAKER_02: We'll move on to question number two, and I think we touched on this a little bit.
• 6:51
  SPEAKER_02: What are some of the barriers to making these changes across an entire organization?
• 6:55
  SPEAKER_02: And how does the culture of the institution play a role?
• 6:58
  SPEAKER_02: Jennifer, we'll start with you.
• 7:00
  SPEAKER_01: So I would say, you know, what Dan just mentioned is incredibly important, and I really look at this in a similar way.
• 7:08
  SPEAKER_01: Barriers include lack of knowledge and lack of appropriate equipment, at least.
• 7:13
  SPEAKER_01: I mean, there's some other barriers too, but those are probably some of the most important.
• 7:17
  SPEAKER_01: So it has to be easy to do the right thing to get people to engage in any behavior.
• 7:23
  SPEAKER_01: So that means having sufficient supplies.
• 7:25
  SPEAKER_01: You have to have gowns, gloves, masks, disinfectant wipes, dedicated stethoscopes, et cetera.
• 7:30
  SPEAKER_01: If those things aren't available, then people may just decide, they may know what to do, but they may just decide that they don't have time, it's not worth the hassle.
• 7:38
  SPEAKER_01: And, you know, I'm often surprised by how long it takes, for example, to get a dedicated stethoscope when I'm seeing someone who is in contact isolation.
• 7:46
  SPEAKER_01: I saw someone recently who had candidoris and a number of other organisms that they were colonized with, and this individual had been in contact isolation for already several weeks.
• 7:58
  SPEAKER_01: And when I went in the room, there was no dedicated stethoscope and there were no disinfectant wipes available outside of the room.
• 8:03
  SPEAKER_01: And when I asked for a dedicated stethoscope, it took a while for someone to actually find one.
• 8:09
  SPEAKER_01: And what that tells me is that people are not following these policies.
• 8:13
  SPEAKER_01: So, you know, these are the policies on paper, but they're not in practice.
• 8:17
  SPEAKER_01: And just to echo what Dan said, so you have to have policies that are actually instituted and people have to actually know that this is what we do in this situation.
• 8:26
  SPEAKER_01: And so anyway, I think you need to make sure that people have the appropriate supplies and they also have to have the appropriate knowledge.
• 8:33
  SPEAKER_01: And then just one last thing that I've noticed is that if we apply isolation precautions too broadly, recently the number of people that we put in contact isolation has increased tremendously.
• 8:46
  SPEAKER_01: And so if everyone you're seeing is in contact isolation, then you stop paying attention to these things.
• 8:52
  SPEAKER_01: It's like constantly being in a state of emergency, people stop paying attention and they develop fatigue around the behaviors and stop doing it when it's really critical to do so.
• 9:01
  SPEAKER_01: So for Canada Oris, we do really want them to follow these behaviors, but it's hard to say, no, we really mean it this time, you know, when you're putting too many people in contact isolation.
• 9:11
  SPEAKER_01: So I think it's really important for institutions to evaluate what they're doing and make sure that they have the appropriate policies in place.
• 9:20
  SPEAKER_01: So true.
• 9:20
  SPEAKER_01: Dan, do you have any additional thoughts?
• 9:24
  SPEAKER_00: Yeah, so there's this old adage in management research that is that uh culture eats strategy for breakfast.
• 9:30
  SPEAKER_00: And so when when you think about you know having all these policies in place, whether it be you know who who ends up in contact isolation or where and when a specific tool or stethoscope is available, it's not just you can have all the policies you want on paper, but as Dr.
• 9:46
  SPEAKER_00: Hanrahead said, you need to actually have them be executed in practice.
• 9:51
  SPEAKER_00: So we did a systematic review a few years ago looking at the evidence for hospital and system-wide infection prevention interventions.
• 10:00
  SPEAKER_00: We found that hospital-wide cultural transformations, such as things like crew resource management, the team steps model, or tiered huddles, did show promise across many studies in supporting change.
• 10:12
  SPEAKER_00: However, it should be noted that these cultural transformation approaches often led to the implementation of other successful strategies such as Cowdy or CLABSY bundles.
• 10:23
  SPEAKER_00: So they did not typically exist alone, but research ultimately is kind of lacking in this area because people either focus on kind of cultural interventions themselves or clinical interventions, but rarely do they do them kind of together.
• 10:36
  SPEAKER_00: And so you can't look at the overlap of those outcomes.
• 10:39
  SPEAKER_00: And ultimately, what this I think tells us is that cultural transformation is kind of the baseline.
• 10:45
  SPEAKER_00: It is it is necessary but insufficient.
• 10:48
  SPEAKER_00: And so you need it to drive and allow for, as Dr.
• 10:52
  SPEAKER_00: Hanrahan said, for it to be easy to do the right thing, but it can't exist alone.
• 10:57
  SPEAKER_00: You need also all these other pieces that are layered on top of it.
• 11:00
  SPEAKER_00: And again, and and I'll I'll probably say this again later on, but you know, it's really thinking about this really strategically and putting all these pieces together so that it's not just one thing.
• 11:10
  SPEAKER_00: And that's what ultimately drives that kind of cultural change.
• 11:14
  SPEAKER_02: Thank you, Dan.
• 11:15
  SPEAKER_02: Well, well, that brings us nicely to the third question.
• 11:18
  SPEAKER_02: Why should we care?
• 11:19
  SPEAKER_02: And how does this impact patient safety?
• 11:22
  SPEAKER_02: Dan, do you want to start with this one?
• 11:24
  SPEAKER_00: Sure.
• 11:24
  SPEAKER_00: Thanks for this, and this is a really great question.
• 11:27
  SPEAKER_00: So the agency for healthcare research and quality administers a survey on patient safety culture and it asks questions in different domains, such as teamwork, leadership support, communication openness, or handoffs and information exchange.
• 11:42
  SPEAKER_00: And some hospitals voluntarily make their data available for research.
• 11:47
  SPEAKER_00: Now, using this data, we recently ran an analysis that looked at the relationship between these domains and the incidence of patient safety events such as CLABSE, COUDI, surgical site infections or MERSA and C.
• 11:59
  SPEAKER_00: diff as well.
• 12:00
  SPEAKER_00: And what we found was that lower rates of CAUDI were associated with higher scores for overall perceptions of patient safety, patient safety grade, communication openness, feedback and communication about error, and supervisor or manager expectations and actions promoting patient safety.
• 12:17
  SPEAKER_00: But we did not observe any other relationships between these domains and other measures of patient safety events.
• 12:24
  SPEAKER_00: We only saw this for CAUDI.
• 12:25
  SPEAKER_00: Now, to be honest, this really surprised me, but I think it highlights that patient safety culture can, one, on the positive side of things, directly tie to improved outcomes.
• 12:36
  SPEAKER_00: But again, it needs to align with other efforts to improve safety and quality.
• 12:41
  SPEAKER_00: So for instance, these domains may support the nurse-driven protocols that I mentioned earlier, but an analog might not exist for CLABSE.
• 12:49
  SPEAKER_00: So there might not be a nurse-driven protocol for CLABSE.
• 12:51
  SPEAKER_00: Other infections like MERSA or C.
• 12:53
  SPEAKER_00: diff just might be more epidemiologically complex.
• 12:57
  SPEAKER_00: And so it's not as clear of how to proceed always.
• 13:00
  SPEAKER_00: But what I ultimately take away is that patient safety culture can improve patient safety directly, or at least contribute to these ongoing efforts, but is not a panacea for improving healthcare associated infection and performance, but rather an important part of strategic efforts to improve quality and safety.
• 13:17
  SPEAKER_00: So to kind of summarize why do we care?
• 13:21
  SPEAKER_00: We care because it needs to be part of this overall strategy.
• 13:26
  SPEAKER_01: Great point.
• 13:27
  SPEAKER_01: Jennifer?
• 13:28
  SPEAKER_01: Yeah, I think we care because you know it impacts patient safety.
• 13:33
  SPEAKER_01: The reality is that when we're not doing the things to prevent infections, then people are potentially getting exposed to pathogens that can make them sick.
• 13:43
  SPEAKER_01: And even if they're not getting sick, but they're getting colonized with them, then it may end up that they get placed in isolation precautions, which can have some negative psychosocial consequences.
• 13:53
  SPEAKER_01: We saw that quite a bit during COVID.
• 13:55
  SPEAKER_01: I frequently use the analogy of bringing your car in for repairs.
• 13:59
  SPEAKER_01: If I bring my car in for repairs, I expect it to be fixed.
• 14:02
  SPEAKER_01: I don't expect it to come back to me with a bunch of additional problems that I'm then gonna have to pay for and take the extra time to go back and forth to get the problems fixed.
• 14:11
  SPEAKER_01: But that's what we're doing to patients in the hospital when we're not implementing infection prevention practices effectively.
• 14:18
  SPEAKER_01: Only the consequences are much, much worse.
• 14:21
  SPEAKER_01: And obviously, humans are much more complicated than cars.
• 14:24
  SPEAKER_01: So I'm not trying to be glib, but I think it's really important to recognize that our actions have real consequences and can make people sick.
• 14:32
  SPEAKER_01: So our job is to take care of people and make them better.
• 14:36
  SPEAKER_00: And I I think there's there's one other piece here, which is ultimately that hospitals are incentivized and and in some ways penalized to improve patient safety.
• 14:46
  SPEAKER_00: So there is not only just kind of the human cost of the morbidity and mortality associated with it, but the actual real financial cost associated with these patient safety events.
• 14:56
  SPEAKER_00: So I mean that that is kind of the the why does the the hospital administrators care is that there's there's real money at play here.
• 15:05
  SPEAKER_00: But you know, I I think it it needs to be stated that that is part of this.
• 15:09
  SPEAKER_02: So, what are some interventions that can be implemented to move infection prevention practices in the right direction?
• 15:16
  SPEAKER_02: Dan, we'll start with you.
• 15:17
  SPEAKER_00: I mentioned earlier we did this systematic review of infection prevention practices.
• 15:23
  SPEAKER_00: And and so, strictly speaking, the best evidence for hospital or system-wide interventions is for the implementation of new technologies to enhance environmental cleaning.
• 15:32
  SPEAKER_00: So, as was mentioned earlier, these don't always happen in practice, but that is where kind of the best evidence lies.
• 15:39
  SPEAKER_00: So these are things like ultraviolet light or hydrogen peroxide vapor or fluorescent markers to give instant feedback to cleaning staff on the quality of their work.
• 15:48
  SPEAKER_00: So that's where kind of the best evidence is.
• 15:50
  SPEAKER_00: But if we take a step back and look a little more generally at how to change culture, and again, I don't want to sound like a broken record, but I think it's really implementing this very strategic approach.
• 16:01
  SPEAKER_00: It's having leadership on board with incentives, EHR systems that support audit and have built-in user-centered alerts, using tiered huddles that encourage interprofessional communication, designing scripting that provides clear messaging when a safety concern is raised, strategically communicating patient safety data to care team members and other stakeholders that includes storytelling, and engaging patients and families through education that encourages their role in patient safety.
• 16:28
  SPEAKER_00: It's not one specific thing, but really creating a patient safety climate and a patient safety culture.
• 16:35
  SPEAKER_01: Great point.
• 16:36
  SPEAKER_01: Jennifer, anything to add?
• 16:38
  SPEAKER_01: I would just say, you know, a couple things that that can be done.
• 16:41
  SPEAKER_01: I I do think it is important for organizations to review all of their infection prevention policies and make sure that they're reasonable, that they're necessary, and that they reflect what's actually going on in that institution.
• 16:53
  SPEAKER_01: And then, you know, it's important to consider for contact isolation, for any kind of isolation, when you start these and and when they can be ended.
• 17:02
  SPEAKER_01: A lot of times people think, oh, we'll just put them in isolation, and then people stay there kind of indefinitely.
• 17:07
  SPEAKER_01: And there's not as much thought as to when to end them.
• 17:10
  SPEAKER_01: Also, as Dan mentioned, I think the cleaning practices, there's a lot of data around this, but it's also really important that hospitals have adequate staffing and that there's oversight for environmental cleaning.
• 17:23
  SPEAKER_01: We have to be sure that items are actually assigned to a specific individual.
• 17:27
  SPEAKER_01: If you go into a hospital room, you need to be able to look at everything in the room and actually figure out who's responsible for cleaning it.
• 17:34
  SPEAKER_01: That may seem easy, but having done this multiple times, I can tell you that it's it's surprising how often there's something that nobody is really sure about.
• 17:44
  SPEAKER_01: And so there has to be auditing and oversight to make sure that these practices are actually occurring.
• 17:50
  SPEAKER_01: And most important, and Dan has said this a couple of times, and I completely agree, there has to be a culture of safety.
• 17:58
  SPEAKER_01: People have to be encouraged to report problems, and then when they do report problems, they need to actually know that something's gonna be done with that information.
• 18:07
  SPEAKER_01: You don't want to have a situation where we're telling people to spend all this time reporting problems, and then they kind of feel like it doesn't go anywhere.
• 18:15
  SPEAKER_01: So you want to let people know that you're serious about this, that you want to know about the problems that people are seeing, and that something's actually going to be done when they take the time to report it.
• 18:27
  SPEAKER_00: I think you raised some some great points there.
• 18:29
  SPEAKER_00: And and one of the things that um comes to mind that I don't know if it was explicitly mentioned or or you mentioned, but is just this staffing issue and this idea of kind of high-performing work practices, and that you've got people who not only have the right skills and the right roles and responsibilities to take these actions, but that you have enough people.
• 18:50
  SPEAKER_00: And that is really a dilemma that's facing healthcare more broadly right now.
• 18:55
  SPEAKER_00: And filling those roles, I think, is really hard because when you have those vacant roles, you have people taking on more than maybe they can handle or doing things that they're not necessarily specifically designated to do or kind of well supported and positioned to do.
• 19:11
  SPEAKER_00: And ultimately, this this creates some resentment over patient safety culture and patient safety actions and just effectively diminishes the implementation of them.
• 19:21
  SPEAKER_02: You've both mentioned some really important considerations.
• 19:25
  SPEAKER_02: And when we go to our final question, I'd like to ask you both, how can a hospital or organizational leadership help to enforce these changes?
• 19:34
  SPEAKER_02: Dan, maybe we'll go back to you again.
• 19:36
  SPEAKER_00: Yeah, thanks.
• 19:36
  SPEAKER_00: I I I mean, this is really a great question because leadership plays such a critical role in supporting this idea of a strategic approach to infection prevention.
• 19:46
  SPEAKER_00: But I do want to push back a little bit on the term of enforcement that describes their role and just put out there that I think it really should be more about encouragement.
• 19:56
  SPEAKER_00: Enforcement can kind of erode this idea of patient safety when people feel like they're being could be potentially penalized.
• 20:03
  SPEAKER_00: You want to make them feel like they are doing the right thing and incentivized to do the right thing as opposed to penalized for doing the wrong thing.
• 20:10
  SPEAKER_00: But I also want to kind of break apart this idea of leaders because there are a lot of different types of leaders in the hospital setting.
• 20:17
  SPEAKER_00: So to start, there are kind of your executive leaders.
• 20:20
  SPEAKER_00: And this includes things like the board and the C-suite that are a bit removed from the front lines of patient care.
• 20:26
  SPEAKER_00: So in the same study I mentioned earlier that included interviews with over 400 key informants from 18 hospitals, we found that engagement of executive leadership in infection prevention can really make a big difference.
• 20:37
  SPEAKER_00: What this means in practice is really two things.
• 20:40
  SPEAKER_00: First, that executive leaders emphasize the infection prevention priorities and goals of their hospitals as they promote infection prevention efforts.
• 20:49
  SPEAKER_00: And second, that executive leaders are visible in their hospitals, which means they do rounds and are available to unit managers and frontline staff for open communication.
• 21:00
  SPEAKER_00: Now, separate from executive leaders, you've also got unit level managers and directors.
• 21:04
  SPEAKER_00: And what we found for them in that same study is that efficient communication about infection prevention is one of the most critical things that they can do.
• 21:12
  SPEAKER_00: So this communication includes sharing information electronically, displaying information on the unit, and discussing information in person.
• 21:19
  SPEAKER_00: We also found that managers and directors need to emphasize the importance of manager coaching to encourage frontline staff to use best clinical practices in infection prevention.
• 21:30
  SPEAKER_00: Specifically, our key informants described two coaching activities: providing staff with feedback on how to perform clinical care processes correctly, and re-educating staff on best practices for infection prevention.
• 21:44
  SPEAKER_00: Now, beyond all of those practices, both for those executive leaders and the unit level managers, we also found that rewards and recognition for French staff go a long way to support continued engagement in infection prevention practices.
• 21:59
  SPEAKER_00: So you can see that there are a lot of approaches that leaders can use to encourage infection prevention.
• 22:04
  SPEAKER_01: Jennifer, any additional thoughts?
• 22:07
  SPEAKER_01: I'm just going to repeat some of what Dan said.
• 22:09
  SPEAKER_01: I mean, I think that hospital leadership really has a critical role because they have to identify patient safety as a priority, and they need to have the information to make the best decisions and give that information to the frontline workers so that they actually know what the problem areas are.
• 22:27
  SPEAKER_01: It's incredibly important for hospital leadership to be visible in patient care areas.
• 22:32
  SPEAKER_01: So don't just send out memos or say that these are policies, but actually go there and see what's going on.
• 22:39
  SPEAKER_01: And the healthcare workers need to know that the policies being made actually mean something.
• 22:43
  SPEAKER_01: And again, you have to have the appropriate resources in place along with the policy.
• 22:48
  SPEAKER_01: So you need to make sure that there's education that takes place when you come up with a new policy.
• 22:52
  SPEAKER_01: You need to make sure that you disseminate the information, that people understand what the issues are.
• 22:58
  SPEAKER_01: And just once again, you know, healthcare workers need to know that when they mention something, when they do see a problem, someone's going to pay attention and help solve that problem.
• 23:07
  SPEAKER_01: Having hospital leadership actually walking around, uh, being visible in patient care areas helps healthcare workers to know that they actually are paying attention.
• 23:17
  SPEAKER_02: Thank you both for such a fantastic conversation.
• 23:20
  SPEAKER_02: We appreciate you joining us today.
• 23:22
  SPEAKER_02: Thank you so much.
• 23:23
  SPEAKER_00: Thank you for the opportunity.
• 23:25
  SPEAKER_00: It was a pleasure.
• 23:26
  SPEAKER_02: You can find more educational content like this podcast on Shay's online education center, Learning C E at www.learningce.org.
• 23:42
  SPEAKER_02: This concludes today's episode of the social and cultural aspects of infection control and antibiotic stewardship series.
• 23:49
  SPEAKER_02: Thank you for tuning in.