A Simple Solution to a Multi-Billion Dollar Problem

For most Americans, $10 billion isn't pocket change. The idea of billions of dollars is somewhat unperceivable simply because of its sheer enormity.

So why are hospitals and healthcare workers throwing this money down the proverbial drain?

The answer has to do with the systemic failure to reduce the prevalence of healthcare-acquired infections. HAIs are far too present in hospitals today, costing the healthcare system $9.8 billion a year, according to a study published in JAMA Internal Medicine. One out of every 20 patients will contract an HAI.

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One of the simplest ways to reduce the number of these infections is simple hand hygiene, yet healthcare workers are failing to adhere to basic hand washing protocol. While hand hygiene compliance rates vary between hospitals, a study published in Infection Control and Hospital Epidemiology found the average compliance rate for proper hand hygiene protocol was 23.2 percent.

Reports show HAIs are decreasing, but hospitals still have a long way to go before these infections cease to pose such a substantive economic burden.

As hospital systems, medical records and surgical tools turn toward the more technologically advanced, so do the efforts to combat hand hygiene noncompliance. One such technology is radio frequency identification, a compliance-tracking intervention that is slowly gaining popularity in the healthcare system.

How it works
RFID tracks individuals' hand hygiene actions using sensor technology that records when a healthcare worker uses a hand washing station, be it a soap dispenser or hand sanitizer. The healthcare worker wears an RFID badge that registers his or her use of the hand washing station. That activity information is sent to an internal server where hospital administrators can receive, review and analyze real-time data.

Additionally, RFID tracks when a healthcare worker enters and leaves a patient room. Proper protocol calls for the worker to wash hands upon entering and upon exiting.

The automatic, cloud-based data gathering element provides more accurate data than observation methods used in the past, says Andrew Klee, infection control practitioner at Guthrie Robert Packer Hospital in Sayre, Pa. Guthrie implemented an RFID system in March 2012 in its oncology unit.

Prior to the RFID system, the hospital was using a "secret shopper" approach to observe and monitor hand hygiene practices, but by the nature of observational bias, the data was not reliable, Mr. Klee says.

Proven results
Hand hygiene compliance for Guthrie's oncology unit greatly improved following implementation of RFID technology. Bonnie Onofre, CNO at Guthrie, says hand hygiene increased from 18 percent compliance to almost 90 percent compliance within five months of introducing RFID, and the improvements were evident in clinicians and staff of all levels.

"It wasn't an issue of educational level of staff or clinicians. It was taking individual ownership," Ms. Onofre says.

As further evidence of the improvements in compliance, hand hygiene stations dispensed 232 percent more soap and sanitizer on the units testing the RFID technology, Ms. Onofre says.

Additionally, the rates of Clostridium difficile fell from two to three infections per month for the unit to zero infections after hand hygiene compliance reached 90 percent, Mr. Klee says.

Hand hygiene: A new habit
More recently, Riverside Methodist Hospital in Columbus, Ohio, implemented RFID hand hygiene tracking on its trauma and intermediate care unit in October 2013, also with promising preliminary results. Compliance on this unit also reached approximately 90 percent.

David Rutherford, nurse manager of the trauma and intermediate care unit at Riverside Methodist, says the end goal of RFID technology is turning proper hand hygiene into a habit so clinicians don't even think about it anymore.

"Over time [clinicians] may forget they are wearing the tracker, and it becomes a habit," Mr. Rutherford says. "It's just a shift in the way we think and operate."

The data gathered from the RFID technology will aid in that transformation because, beyond initial compliance improvements due to being observed, the data can be used to assess the impact of interventions on compliance rates. And, because the data now captures the habits of every person in the unit, the data is more reliable, Mr. Rutherford says.

"Having aggregate data with lots of observations gets the data more accurate," he says. "By having this aggregate data you can see if I have 80 percent compliance today [and] we implement this change and it goes to 90 percent, we can know that's something."

Mr. Klee agrees with the idea that the collected data is imperative to a culture change. Guthrie plans on implementing RFID onto other units in the future. However, "it's not just about rolling out a system. You have to be able to use the data and the accountability tied to it. Otherwise we just have good reports," Mr. Klee says.

That self-accountability is a driving force in the future of hand hygiene compliance, Mr. Klee says, especially given the role healthcare workers play in the spread of HAIs.

"As healthcare workers, we are the ones by and large responsible for [HAIs] being spread from patient to patient," he says. "We're the ones that are responsible for tracking that into and transmitting it into the patient. If we can identify and mitigate those factors, we can go a long way forwards."

And technology and big data are going to be there to help.

"It is really about people not taking the time to do the things they should be doing and not following basic hand hygiene principles," Ms. Onofre says. "That's the beauty of the system. The system doesn't lie."

More Articles on Hand Hygiene:

3 Important Questions For Monitoring Hand Hygiene Compliance
Even While Recording Failures, Healthcare Workers Say They are Hand Hygiene Compliant
The Road to Eliminating HAIs: Hand Hygiene Improvement at Cedars-Sinai

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