Taking hand hygiene high-tech

For healthcare providers, following hand hygiene protocol is one of the simplest actions they can take to reduce the instance of healthcare-associated infections. Indeed, the World Health Organization calls hand hygiene a "simple, low-cost action to prevent the spread of many of the microbes that cause healthcare-associated infections."

"Hand hygiene is definitely the most important thing we can do to prevent infection," said Clare Nash, RN, program manager at The Royal Wolverhampton NHS Trust in the United Kingdom, during a presentation. "It's vital that we perform hand hygiene as best as we can and give staff information on how they're doing."

Despite the wealth of evidence supporting the importance of performing hand hygiene, compliance among healthcare workers remains low. To that end, hospitals, health systems and researchers worldwide have come up with different ways to measure workers' compliance with hand washing recommendations as well as encourage compliance.

Some organizations use the direct observation approach, having trained observers monitor workers when they perform hand hygiene. But that approach has its limits, as workers become more likely to practice proper hand hygiene when they know they are being observed — a phenomenon known as the Hawthorne effect.

Self-reporting of hand hygiene is also a less-than-perfect way to track compliance rates, as self-reported numbers are usually higher than the actual rates.

In fact, just 13 percent of nurses and infection preventionists in U.S. hospitals are "extremely satisfied" with the reliability of their facility's hand hygiene compliance data, according to a 2014 survey.

To overcome such limitations and lack of accurate data, Ms. Nash's hospital in the U.K. decided to take a more technology-driven approach and installed a real-time locating system to monitor staff hand hygiene adherence, using TeleTracking technology.

How it works

Workers wear an identification badge with a wireless receptor as part of their uniform, and additional sensors are located on hand gel and soap dispensers at the foot of each patient bed and on ward sinks. The sensors record when a healthcare worker with a badge enters and exits the room and also if they used the sanitizing dispenser or not after entering and before exiting.

In this way, the system keeps track of providers' compliance with three of the World Health Organization's five moments for hand hygiene: before touching a patient, after touching a patient and after touching patients' surroundings. If a worker performs hand hygiene twice while in patient room, they get a score of 100. If they do it just once, they get a score of 50.

Ms. Nash's hospital installed the system in late 2013. Currently, more than 4,000 staff members — including nurses, the director of nursing, physicians, and patient transporters — have RTLS badges that track their hand hygiene compliance. Compared to manual observation of hand hygiene behavior, the system keeps track of far more hand hygiene occurrences: In the same month, the system tracked 1 million observations, compared to just 600 visual observations.

While the wealth of accurate data is an improvement over manual observation in and of itself, taking a high-tech approach to hand hygiene also allows infection control professionals to track compliance — and give feedback — in real time. Information is fed to a system that can display compliance levels on an individual or unit basis.

Staff reaction

Staff members at Ms. Nash's hospital were already somewhat familiar with RTLS technology, as the hospital uses similar technology to track assets and patients, making the transition to hand washing compliance tracking a little smoother. But, in general, Ms. Nash said a good way to ease acceptance is to frame the technology in the right way.

"We had to get the staff to believe in the system and the benefit of wearing the badge," she said. "We don't use it as a way to find out what they're not doing, but to prove they're doing a good job. Staff want to come to work to do a good job, and do the right thing, any technology helping them achieve that has to be positive."

Framing the program in a constructive, rather than destructive, way has helped officials gain front-line acceptance.

"We need to make sure we use technology in the best way we can to help staff do the right thing," Ms. Nash said. "That's what this is helping us do in our organization."

Since installing the system and using its real-time data to provide feedback to the staff, the hospital has seen "gradual improvement" in compliance, and a focused effort on practice according to Ms. Nash — and, as the saying goes, what gets measured gets managed, so more improvement in compliance is sure to follow.

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