Stakes are high: Leaders should be hands-on when it comes to hand hygiene

Health systems spend millions obtaining the latest technology to create state-of-the-art facilities and to build reputations for quality and innovation. But failing to maintain consistency in relatively low-tech, low-cost infection prevention strategies like hand hygiene can undermine reputation, patient outcomes and the financial bottom line across all practice areas.

Avoidable infections caused by inadequate hand hygiene result in worse patient outcomes — including avoidable procedures, higher antibiotic use, extended stays, more infections and deaths. Care is further complicated by the downstream consequences of added antibiotic exposure. And yet, insurance may not cover additional care for patients who acquire an infection while hospitalized. Each day, one out of every 31 hospitalized patients in the U.S. develops a healthcare-associated infection. The cost of just one such infection can range from $1,000 to $50,000, and these infections cost U.S. hospitals  $28 billion to $54 billion a year.

The impact goes beyond the direct costs. Healthcare-associated infections can result in lawsuits and reputational damage. Infection rates are reported in external quality and safety programs used to evaluate hospital performance, where they can create lasting damage to a hospital's reputation in the community — affecting market share and ability to recruit and retain staff. CMS has linked performance around healthcare-associated infections to reimbursement levels and penalties, putting hospitals with poor outcomes at risk for substantial revenue losses. On a societal level, preventable infections lead to increased exposure to antibiotics, contributing to the public health threat of antibiotic resistance.

Achieving and maintaining high hand hygiene adherence rates can be challenging because it requires consistent performance among a large number of workers involved in providing care and services to patients. Five top organizations in infection prevention and control, led by the Society for Healthcare Epidemiology of America, created an evidence-based framework to guide facilities in establishing hand hygiene best practices. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene: 2022 Update, released in January, addresses training, monitoring, placement of alcohol-based sanitizers dispensers and sinks, as well ways to promote workers' healthy skin and nails.

Leadership is the key to ensuring tested strategies like these are successfully deployed.

Make it a priority. Healthcare leaders must be hand hygiene champions, making hand hygiene an organizational priority. This is easier said than done because hand hygiene is often considered low-tech and unglamorous, and healthcare personnel often mistakenly assume their own hand hygiene is adequate. Improving hand hygiene practices across the organization requires inspiring and steadfast commitment by leaders to motivate hundreds or thousands of individuals to change their behavior and to build good hygiene practices into their standard workflow.

Establish a strong implementation team and a clear plan. A strong program begins with understanding hand hygiene compliance rates by monitoring process measures and identifying the reasons for gaps in best practices. Reasons can include insufficient education about the impact of hand hygiene on patient safety, inadequate hygiene training, or a lack of easy access to hand hygiene products when and where they are needed. Creating an environment for consistent and effective hand hygiene requires adequate infection prevention and control staffing to establish and implement a hand hygiene program, including a monitoring system, and the expertise to evaluate and act on data collected.

Define and measure success. Implementing and sustaining hand hygiene improvements must include clear performance measures and goals as well as mechanisms to provide timely feedback to the appropriate groups that are accountable for using this information to identify and test changes needed to achieve timely and ongoing improvement.

Healthcare executives and leaders have a crucial role in building an organizational culture committed to patient safety through infection prevention and in building and sustaining the infrastructure required to make it a reality. Effective hand hygiene protects patients, healthcare personnel, and the organization’s financial bottom line, and it enables us to provide safe, high-quality health care to even the most vulnerable of our patients.

Dr. Yokoe is president of the Society for Healthcare Epidemiology of America and Professor of Clinical Medicine in the Division of Infectious Diseases, at University of California, San Francisco. Margaret VanAmringe is executive vice president of public policy and government relations for The Joint Commission. Both authors were part of the writing team for the update to Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene.

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