Healthcare leaders are under pressure to drive quality improvement, eliminate hospital-acquired conditions to avoid penalties and increase economic efficiencies. They know direct observation is unreliable but fear some electronic systems are not clinically proven to accurately measure the World Health Organization's 5 Moments for Hand Hygiene in real time.
It's time to take action with the DebMed Electronic Hand Hygiene Compliance System.
The following content is sponsored by DebMed
Drive Clinical Outcomes With Reliable Hand Hygiene Compliance Data
The topic of hand hygiene continues to be at the forefront of patient safety discussions. No wonder — the latest figures from the CDC show that 700,000 people in the U.S. contract a healthcare-associated infection each year, resulting in countless additional inpatient days, readmissions, complications, increased costs and approximately 75,000 deaths annually. Today, only 40 to 50 percent of most hospital workers wash their hands when they are supposed to.1
The Hidden Dangers of Relying on Direct Observation
Many hospitals, however, boast compliance in the 90 percent range.2 The discrepancy is the result of hand hygiene compliance often being measured by "secret shoppers," human observers equipped with clipboards and pens. Unfortunately, the direct observation method is greatly flawed. Here's why:
- Direct observation is typically performed by staff members when time permits, so observers capture only a small fraction of all hand hygiene behavior.
- Direct observation typically doesn't capture any of the opportunities or events that should be happening inside the room around the patient zone.
- With staff observing their own colleagues, there is a risk of bias and what is known as the Hawthorne effect, meaning people will act differently when they know someone is watching them. In fact, direct observation can be overstated by as much as 300 percent.3
The danger of inflated compliance numbers achieved through direct observation is that they give hospitals a false sense of security, which leads to complacency and inaction. As a result, infections occur, causing pain and suffering and costing lives. When hospitals know their real rates, a sense of urgency emerges to drive the improvement.
A Proven Approach With DebMed Electronic Measurement Technology
DebMed recognized the need for accurate hand hygiene compliance measurement and embarked on a research journey to design, develop and validate a way to measure hand hygiene accurately and reliably in real time to reduce HAIs.
The company launched the concept of electronic compliance measurement with its innovative technology that accurately and reliably measures 100 percent of hand hygiene events, alleviating the issues inherent in direct observation. With electronic measurement, hospitals obtain accurate hand hygiene performance data and can provide actionable feedback to staff to drive behavior change that, in turn, results in increased compliance and decreased infection rates.
Having pioneered the technology, DebMed remains a leader in the electronic measurement field. DebMed's technology is based on the World Health Organization's 5 Moments for Hand Hygiene guidelines, which represent a higher clinical standard that facilities across the U.S., Canada and the world are implementing to enhance patient safety and infection control. Because of this, the number of hand hygiene opportunities reported by the DebMed system will be different and more accurate than systems that only monitor hand hygiene before and after contact with a patient, or room entry and exit.
A Missing Link: Financial Penalties and Hand Hygiene Compliance
In addition to improving patient safety and clinical outcomes through reducing HAIs, increased hand hygiene compliance can greatly impact a healthcare organization's financial situation. Hand hygiene non-compliance is expensive, as the government has moved to increase healthcare penalties for all facilities to reduce their total HACs.
CMS added a new penalty for hospital-acquired conditions, including HAIs. Hospitals can lose 1 percent of their total CMS revenue if they fall into the lowest-performing quartile of U.S. hospitals. Moreover, methicillin-resistant Staphylococcus aureus and Clostridium difficile infections are being added as part of the HAC monitoring penalties this year — two infections notoriously linked to hand hygiene. In 2015, 724 hospitals were penalized, and 758 are being penalized in 2016, 54 percent of which are in the penalty zone for the second time.4
One of the simplest ways to reduce HAIs and their associated HAC penalties is hand hygiene compliance, and electronic monitoring has been proven to improve hand hygiene behavior and increase compliance rates.
Clinical Outcomes Speak for Themselves
A number of hospital systems have conducted early research and pilots to help develop and validate electronic monitoring systems. In a video validation study conducted at a 750-bed teaching hospital in Greenville, S.C., hand hygiene compliance was measured on the same patient population for a 15-month period in three different ways: direct observation, video monitoring (with patient consent), and the DebMed compliance system. The rates of compliance measured by video monitoring and the DebMed system were statistically equivalent for the final 12 months of the study, while direct observation overstated compliance by an average of 33 percent. The study proves the accuracy and reliability of the DebMed electronic compliance system and that the Hawthorne effect produces overstated and unreliable compliance rates.5
Other hospitals are beginning to achieve similar results. Following implementation of a DebMed electronic monitoring system at a suburban Chicago hospital, overall hand hygiene compliance increased from 57 percent in December 2013 to 79 percent in September 2015 — a 39 percent increase. Additionally, the rate of healthcare-associated MRSA dropped from 3.94 to 1.98 cases per 10,000 patient days — a 50 percent reduction. The facility paid no readmissions penalties in 2015 and was one of only seven hospitals in Illinois that paid no ACA-related penalties in 2015. In comparison, the facility had paid a 0.24 percent CMS readmissions penalty in 2013 before implementation of the DebMed system.6
No Time Like the Present to Adopt Electronic Monitoring
Direct observation will continue to play an important role in hand hygiene compliance to discover and overcome barriers, give feedback on technique, and evaluate performance of specific groups. However, the evidence is clear that direct observation is not an adequate compliance measurement tool. Electronic measurement better enables accountability and can drive real performance improvement from an honest baseline.
Now is the time to introduce electronic measurement into your facility. The DebMed system is the only research-based, badge-free system capable of capturing all hand hygiene events based on the WHO 5 Moments for Hand Hygiene guidelines.
The DebMed System:
- Is clinically proven to drive better outcomes — peer-reviewed studies demonstrate increased compliance, reduced infection rates and significant cost savings
- Captures all opportunities beyond just room entry and exit
- Is economically affordable, requiring no capital investment
- Has shown positive return on investment in less than one year
- Delivers powerful reporting with robust, easy-to-read, web-based reports and a comprehensive online toolkit
- Provides complete training, education and engaging support to drive lasting behavior and culture change
As healthcare facilities strive to create a safer environment for patients, their families, staff and visitors, proper hand hygiene is the easiest and most cost-effective way to help achieve the goal. The DebMed Electronic Hand Hygiene Compliance System can help to reduce HAIs and associated financial penalties and enhance patient safety culture.
References
1 McGuckin, M., Waterman, R., & Govednik, J. (2009, March). Hand hygiene compliance rates in the United States — A one-year multicenter collaboration using product/volume usage measurement and feedback. College of Population Health Faculty Papers, 24(3), 205–213. doi:10.1177/1062860609332369
2 Coyne, T. (2014, July 25). Ontario hospital staff not washing hands as often as reported: Study. Toronto Star. Retrieved from http://www.thestar.com/life/health_wellness/2014/07/25/ontario_hospital_staff_not_washing_hands_as_often_as_reported_study.html
3 Srigley, J. A., Furness, C. D., Baker, G. R., & Gardam, M. (2014). Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: A retrospective cohort study. BMJ Quality & Safety, 23, 974–980. doi:10.1136/bmjqs-2014-003080
4 Evans, M. (2015, December 10). Half of hospitals penalized for hospital-acquired conditions are repeat offenders. Modern Healthcare. Retrieved April 17, 2016, from http://www.modernhealthcare.com/article/20151210/NEWS/151219988
5 Diller, T., Kelly, J. W., Blackhurst, D., Steed, C., Boeker, S., & McElveen, D. C. (2014). Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: Validation of the HOW2 Benchmark Study. American Journal of Infection Control, 42(6), 602–607. doi:10.1016/j.ajic.2014.02.020
6 Bouk, M., Mutterer, M., Schore, M., & Alper, P. (2016). Use of an electronic hand hygiene compliance system to improve hand hygiene, reduce MRSA, and improve financial performance. Accepted for presentation at the annual conference of the Association for Professionals in Infection Control 2016.