Advances In Hand Hygiene Compliance

Hand hygiene is the most effective means of reducing hospital-associated infections (HAIs.) Infection prevention is critical to saving lives and reducing cost of care. Yet maintaining a high level of hand hygiene compliance continues to be a real challenge. Hospital visitors may not be aware of the need to use handwashing stations available in hallways, and healthcare workers (HCWs) often miss opportunities for proper hand hygiene due to a variety of reasons.

Determined to improve quality of care, hospitals are employing new and novel means to help HCWs comply with hand hygiene requirements and maintain high levels of compliance.

Targeted Solutions Tool®

In 2006 Memorial Herman Hospital System (MMHS,) consisting of 12 hospitals and over 200 alternate-site facilities and programs, set the goal of becoming a high reliability organization (HRO.) HROs maintain high levels of quality and safety over long periods with few adverse events.

Working toward this goal, Robust Process Improvement® projects proved effective in reducing HAIs, but more could be done by addressing hand hygiene compliance. MMHS implemented the Joint Commission Center for Transforming Healthcare’s Web-based Targeted Solutions Tool® (TST®.)

The TST enabled MMHS to measure compliance rates using secret observers, identify reasons for noncompliance and implement tested interventions provided by the TST. Most importantly, they were able to sustain those improvements.

MMHS found that the number one contributing cause of hand hygiene noncompliance at their hospitals was improper use of gloves, which includes not washing before or after wearing gloves. Other frequent contributing causes included frequent entry and exit of patient areas, hands being full of supplies, being distracted or forgetting, following a person during entry or exit, and ineffective or inconvenient placement of hand gel dispensers or sinks.

Interventions to increase compliance included using a code word to remind a distracted person to perform hand hygiene, relocating or adding hand gel dispensers, and providing a surface for HCWs to place supplies and medications so they could perform hand hygiene.

MHHS’s system-wide hand hygiene compliance averaged 84.4% during the “improve” phase compared to the baseline average of 58.1%. They ultimately achieved 95.6% compliance in the final 12 months of the study. All that effort paid off with fewer HAIs. Adult ICU central line-associated bloodstream infections decreased by 49%, and ventilator-associated pneumonia decreased by 45%.

To sustain these gains, MMHS continues to collect and input data on hand hygiene compliance, and each hospital’s hand hygiene team is responsible for sustaining performance.

Remote Video Auditing (RVA) with Feedback

For a more high-tech approach, a technology that has been shown to dramatically improve hand hygiene compliance in the food processing industry is now doing the same in hospitals – RVA with feedback.  The system captures and audits images and provides real-time feedback to practice areas. While it sounds ominous – cameras watching your every move – it encourages compliance in a positive way with a non-punitive approach.

NS-LIJ’s North Shore University Hospital in Manhasset, NY employed the RVA system from Arrowsight to improve hand hygiene compliance in their medical intensive care unit (MICU.) The baseline snapshot of compliance before feedback was low, around 10 percent.

Over a 16-week period, HCWs were monitored and received real-time feedback in aggregate on LED screens mounted on the walls of the MICU and from team leaders. Each shift was able to clearly see their compliance rate which naturally motivated improvement. Within weeks the hand hygiene compliance rate soared to 80 percent, then reached a sustained rate of 90 percent during the 17 month maintenance period.

Some feel this method is superior to “secret-shoppers” or observation by individuals with clipboards in hand. When we know we are being watched, we act differently.

His Eyes Are On You

Even when we aren’t being watched, just the image of a man’s intense staring eyes above a handwashing station can prompt compliance.

Employing behavioral science, researchers at a teaching hospital in Miami found that a picture of a man’s eyes increased hand hygiene by one-third at an intensive care unit. Interestingly, a picture of a woman’s eyes saw a lower compliance rate than no picture at all. This may be because of gender differences in exerting social influence, or it may have just been because the man’s eyes showed more facial musculature, which is perceived as anger or a threat. In any case, this low-tech “cue” works.

Figure 2. 

Pure Hold Hygiene Handles

PureHoldDoor knobs and handles are notorious for harboring germs, making them common sources of infection transmission. Frequent wipe-downs with a germicide are not enough to halt viruses looking for their next ride.

Enter the Pure Hold Hygiene Handle. It sprays a hand sanitizing gel on the person’s hand as they open the door. Lab testing and trials have proven that these sanitizer dispensing door handles are 98.5 percent cleaner than a standard door handle.

The hands that open them are also cleaner. At Queen Alexandra Hospital in Portsmouth, hands that used the system were 87.5 percent cleaner than those that did not. The special handles are also used in the cleanroom, pharmaceutical and food processing industries to reduce possible contamination of critical environments. Employing the door handle as the method of dispensing handwashing gel ensures that more people comply with efforts to stop viruses and HAIs.

Hand hygiene compliance, including the proper use of medical gloves, is a critical factor in reducing HAIs. Increasing and maintaining that compliance among healthcare workers is made possible by employing new and novel methods and technology.

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