Standard infection prevention practices like handwashing are simple in theory but difficult to sustain in practice, and Vanderbilt Health has designed a program to make them instinctual for staff.
The program, now in its 17th year, recently logged its 1 millionth observation. It’s designed to turn common infection prevention actions — such as handwashing, wearing isolation personal protective equipment, cleaning the environment and prevention practices around devices — from another task to do into an ingrained habit, Tom Talbot, MD, medical director for infection prevention at the Nashville, Tenn.-based system, told Becker’s.
“Opportunities to do them occur often every day and lapses can be common especially when one is busy,” he said. “It has to be a habit, ingrained in what you do. If I’m busy, running into the room, and the patient’s sick, do I reflexively remember? It should be instinctual, not something I stop to do. So what you have to do is engineer a system where it becomes behavioral.”
The program has achieved high rates of hand hygiene with four elements:
- Clear expectations set from the top down, and a culture where staff remind each other to wash their hands
- In-the-moment feedback from colleagues
- Supplies placed within the workflow
- Performance feedback with an accountability structure when performance falls below shared goals
To track compliance, the system uses “secret shoppers” to observe handwashing, and direct observations, audits and EHR data for other measures, Dr. Talbot said. The infection prevention team also rounds to help teach, monitor and inform leadership of gaps.
“We try to measure not only the outcome measures like CLABSI, CAUTI and surgical site infections but where possible, other process measures,” he said. “Events are usually rare, so seeing if we are adhering to expected, evidence-based processes on every patient and addressing variability in care or reductions in compliance is key. Some process measures we track include surgical infection prevention metrics around antibiotics, glucose and temperature control; catheter dressing changes; Staphylococcal decolonization practices, and use of the urinary catheter discontinuation protocol.”
These simple infection prevention strategies are important to reduce in-hospital transmission of dangerous infections. The CDC’s 2026 “Antimicrobial Resistance Threats Report,” published Oct. 27, estimates that the urgent, serious and concerning pathogen threats result in an estimated 9.7 million infections and 50,800 deaths each year. Six of the 19 pathogens spread easily in hospitals.
