Hand hygiene in 2015: Embrace the new number

For years, healthcare organizations have attempted to get an accurate measure of hand hygiene compliance to determine compliance rates and how they tie in with infection rates. But the most widely used method of compliance measurement — visual observation — presents some challenges.

For instance, results from direct observation of healthcare worker hand hygiene can be limited by the Hawthorne effect, or the phenomenon of people changing their behavior when they know they are being observed. Despite the best efforts to collect the data accurately, this can result in inflated compliance rates. Also, observers can only be in so many places at once, thus missing the vast majority of hand hygiene opportunities.

Now, new technologies have been created to better measure compliance rates. Many hospitals use real-time location systems or mini wireless networks within the hospital to track employee movement and hand sanitizer use via sensors in dispensers. These methods provide much more accurate compliance rates in near real time — but those numbers aren't always pretty.

"The primary reason for implementing an electronic hand hygiene monitoring system is that it allows for the collection of robust data that is statistically significant, unbiased and actionable," says Dave Mackay, vice president of healthcare for GOJO Industries, a producer and marketer of skin health and hygiene solutions. GOJO works with clients to gain an understanding of compliance levels and build strategies for improvement.

However, compliance rates gathered by these systems aren't always pretty.

"As more and more health systems begin to use these new technologies, they are realizing compliance rates are nowhere near what had been previously reported," Mr. Mackay explains.

It's easy to view this as a setback — some hospitals could see their hand hygiene compliance rates drop from 90 percent to around 40 percent, for instance. Concern can be alleviated by reframing the issue. "It is important to remember that this is not a reduction in hand hygiene compliance. It is introducing a new baseline for measurement," Mr. Mackay says.

He adds that, "Leadership should not try to reconcile the old number to the new baseline with a different measurement method because it is an apples and oranges comparison. We should celebrate the fact that we now have an objective measure."

He encourages hospitals to use this number as the baseline and focus on improvement. "It's hard to fix a problem if you don't have a true picture of the current state," Mr. Mackay says. If there is no awareness or recognition of a problem, time, energy and funds could possibly go to improvements elsewhere and not on improving hand hygiene compliance.

Such a redirection of resources would be bad news for infection preventionists passionate about the issue as well as patients because when hand hygiene compliance rates increase, there are published studies that demonstrate that HAIs decrease. When the hand hygiene issue isn't addressed, hospitals limit their ability to decrease HAI rates and could subject themselves to penalties from CMS, which now cuts payments to hospitals with high infection rates.

After the industry accepts these lower, more accurate rates of hand hygiene compliance, it can begin real work to address issues in individual facilities that hinder hand hygiene, and technology can give new insight into what is causing the problem.

Using technology to track hand hygiene compliance can show hospital leaders which units, floors or even individual employees are "shining stars" when it comes to hand hygiene compliance, and it can then investigate by looking at trends and patterns to see what those areas or people are doing right. "It [the tracking system] is a tool to help facilitate improvement," Mr. Mackay says.

A recent study in The Joint Commission Journal on Quality and Patient Safety listed 24 main issues that caused healthcare workers to miss a hand hygiene opportunity in eight hospitals, and Mr. Mackay offered the following common reasons for hand hygiene noncompliance:

  • Location of the product is inconvenient. Sanitizer dispensers and sinks need to be "in the right location to facilitate use at the point of care," he says.
  • Having the right products available. Some hand cleaning products can be rough on workers' skin, drying it out and making it unpleasant to use, thus discouraging healthcare workers from performing hand hygiene at every opportunity. "The experience has to be a good experience," Mr. Mackay says of using hand hygiene products.
  • Visible organizational support. "In order to reach hand hygiene compliance goals, it is necessary for the entire organization to understand the goal and how they can reach it together," Mr. Mackay explains. It is critical that leadership is visibly supportive of hand hygiene initiatives and is committed to removing barriers that may prevent success.

Embracing the new hand hygiene compliance numbers, generated through monitoring compliance with technology, can help leaders uncover their facility's own hand hygiene issues like these and start addressing them — hopefully leading to higher compliance rates, improved patient safety and fewer HAIs.

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