An 'easy sell' for leaders: How UTMC is tackling hand hygiene with a new compliance system

In mid-February, the University of Tennessee Medical Center in Knoxville launched a pilot program to test out a new hand hygiene compliance system.

Physicians, nurses, therapists and environmental services personnel working in two units at the hospital wore badges that interface with beacons in wall-mounted hand hygiene dispensers and patient rooms to track hand hygiene compliance. After two months of 24/7 monitoring, the units reported an average compliance rate of 89.4 percent, marking a significant improvement for the medical center. Now, UTMC is preparing for a hospitalwide go-live on Sept. 16. 

"We know we're going to hit some challenges with the implementation because this is a big change," said Jenn Radtke, MSN, RN, manager of infection prevention at UTMC. However, she's confident the system's long-term benefits will far outweigh implementation obstacles.

"Not only will this help patients and families, but hopefully it'll help our staff members get sick less," she said. "If they're washing their hands more, we'll have decreases in absenteeism, and it will be safer overall for everyone in our organization."

Here, Ms. Radtke and James Shamiyeh, MD, senior vice president and chief quality officer at UTMC, discuss their motivation for implementing the new system and its expected benefits for the hospital.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What was the motivation behind implementing UTMC's new hand hygiene compliance system?

Jenn Radtke: We did a big hand hygiene push in 2018 with a new campaign, but after a while our numbers plateaued. Late last year, our CMO at the time came to us and asked if we'd ever heard about these types of hand hygiene systems. In the past, we used secret shopper observations to get our hand hygiene compliance data, and that's only good as long as someone is unknown to the staff. Otherwise, you get the Hawthorne effect. We were really just looking to push it to the next level.

The Ecolab system we selected is a reminder system, not just a compliance monitoring system. We wanted a product that wasn't just Big Brother watching but was actually there to help the clinician. Clinicians don't forget to wash their hands on purpose, just like drivers don't forget to use their turn signal on purpose. We wanted a system that could act like a seat belt reminder for our employees when they forget to wash their hands.

Q: How did you get C-level leaders on board with the new hand hygiene system?

Dr. James Shamiyeh: I cannot minimize the importance of the pilot. It absolutely helped us make this decision. The system was an easy sell, for one, just in terms of how much improvement we saw in a very short amount of time. If you just implement the secret shopper approach, you are not able to intervene at the exact moment a provider is about to interact with a patient. The fact that the system allows us to have a real-time intervention with the badge chirping was another selling point. From the C-level perspective, every one of these healthcare-associated infections comes with a significant cost. If you do believe, like us, that hand hygiene is the No. 1 way to combat and prevent those, then making a financial case in terms of the number of infections prevented and what that saves the hospital was not a difficult case to make. 

JR: It's important to note, too, that the patient is at the center of every discussion and everything we do in this organization. When you bring it back to the benefits for the patient, that makes it sell easily, as well.

Q: How will this system better allow for hand hygiene coaching?

JR: For years, front-line managers in our hospital have asked for the names of people who are not performing hand hygiene on their unit so they can coach them. Obviously, we can't ask our secret shoppers to confront someone to get their name. The infection prevention team can do some real-time coaching, but we don't want to be perceived as the bad guy for reporting things back. With these badges, every team member will get a report card each month that will tell them how they are personally doing. It will also allow for managers to see how staff members are doing and if there are improvement opportunities.

From the nursing perspective, the units that piloted the system really liked receiving that feedback. They would go to their managers on a regular basis to see how they are doing. As much as we hated report cards in school, everybody wants to know how they're doing. This system provides real data for that. 

JS: We in no way intend to use this information in a punitive manner. It's ultimately about having a better sense of what's really happening in the hospital and using it for coaching.

Q: What advice would you give other hospitals looking to implement a hand hygiene compliance system?

JR: You want to figure out who your early adopters and resisters will be, as with any compliance improvement initiative. You want to make sure you have some of those resisters on your team. Once you get their buy-in, it will be easier to get buy-in from others. With any new process, there will always be growing pains. It's just a matter of working your way through them. Keeping the patient, family and staff at the top of your mind is also important as you're looking at systems.

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