Perfecting the basics helps healthcare fight the unexpected 

Whether we were told to wash our hands for 20 seconds or encouraged to sing "Happy Birthday" while we lathered up, we learned from a young age that hand-washing is an integral part of preventing sickness and germs. That’s still true, no matter if we’re trying to avoid catching the common cold or prevent the spread of deadly outbreaks. 

Despite widespread knowledge about the importance of hand hygiene, studies show that healthcare workers wash their hands less than 50 percent of the time that they should. Less than perfect handwashing has a devastating effect: Nearly 700,000 patients get a hospital-related infection every year, and that infection claims the lives of 72,000 people. 

Healthcare’s inability to solve the hand-washing puzzle has a ripple effect. When the things that should be easy are still difficult, can we feel confident in our ability to address the hard problems? And when we’re still trying to solve the basics and teach the consistent application of foundational actions — how can we ever be truly prepared for the unexpected? 

Tackling this challenge starts with a critical question, the answer to which varies from facility to facility, from unit to unit and different settings of care: Why aren’t caregivers washing their hands every time? We need to understand the reasons why people find it difficult to clean their hands consistently. Understanding the root causes of hand hygiene failures is crucial to developing solutions that work and that last.

Some of the causes are driven by logistical considerations. Healthcare workers are busy and have their hands full — literally and figuratively. While tending to patient needs and working eight- to 12-hour shifts, caregivers often juggle treatments, medications, needed equipment and patient charts, leaving their hands full and inaccessible before they enter patient rooms. Even the location of sinks and hand dispensers can serve as an obstacle to caregivers who spend most of their days on their feet and who may not veer off their typical path to hit the sanitizer station or designated hand-washing sink. There are dozens of causes, but an organization won’t know its most important contributing factors unless it takes the time to investigate and learn.

As healthcare strives for the consistent excellence that is a hallmark of high reliability organizations, there needs to be an understanding that persistent problems in healthcare persist because they are complex. While the root causes of these quality and safety problems are likely to be influenced by local factors and will differ from place to place, the solution is universal: structured data-driven discovery that leads to an understanding of the causes of failure. 

This means stepping back and figuring out why the problem is happening, finding out why it persists, looking at the contributing factors, then developing solutions that target an organization’s most important and impactful causes of failure. This level of rigor is critical to weathering large-scale issues that tax a system that seems to operate close to capacity.  

Hand hygiene compliance is the perfect example of a seemingly simple problem that we have been solving over and over again for the past 200 years. Getting hand hygiene to 100 percent compliance is one of the many ways healthcare leaders commit to zero harm. Like every big goal, setting the target is only the first step. Organizations then have to take the time to learn about the weaknesses in their systems and implement solutions that strengthen those systems. Deploying solutions that are aimed at removing an organization’s most impactful causes of failure creates an environment where it becomes easy for caregivers to do the right thing — in this case, wash their hands.

Making the commitment to hand hygiene — to solving this persistent issue for good — will have a significant positive impact. Studies show organizations that participated in a hand hygiene project were able to increase hand-washing compliance dramatically, with corresponding drops in HAIs. Let’s commit to being part of the solution and investigate the barriers to hand hygiene compliance in our facilities.  Let’s make hand-washing as easy as it was when we were kids.   

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