There’s no doubt that hand washing is the best way to combat potentially deadly germs and keep patients and healthcare providers safe. If you're looking to prevent the spread of infections, including ones that are resistant to antibiotics, hand hygiene will be at the top of the list. How do you ensure it happens in your facility? Do you use technology?
Hand Hygiene in Healthcare: Benefits & Challenges
The Benefits of Clean Hands
"Handwashing can help prevent illness. It involves five simple and effective steps (Wet, Lather, Scrub, Rinse, Dry) you can take to reduce the spread of diarrheal and respiratory illness so you can stay healthy. Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. It’s quick, it’s simple, and it can keep us all from getting sick. Handwashing is a win for everyone, except the germs."
If soap and water aren't an option, there's always hand sanitizer:
"Washing hands with soap and water is the best way to get rid of germs in most situations. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label."
Handwashing Compliance is a Challenge
As simple as these hand hygiene options are, ensuring that they happen consistently in healthcare environments is a challenge. Again, the CDC states that,
"On average, healthcare providers clean their hands less than half of the times they should. On any given day, about one in 31 hospital patients has at least one healthcare-associated infection."
"Hand hygiene is the most important factor in preventing the spread of healthcare associated infections (HAIs), a major threat to patient safety and cause of morbidity and mortality worldwide. Beyond their human costs, HAIs are fiscally costly, accounting for billions of dollars’ worth of expenditure in the U.S. healthcare system annually. Studies substantiate the connection between hand hygiene and HAIs; however, hand hygiene compliance among healthcare workers (HCWs) remains alarmingly low, with average rates of only 40 percent to 50 percent, in spite of widespread education and awareness."So how is it that something so simple and effective can be so difficult?
Ensuring Hand Hygiene Compliance
Perhaps some of the challenge has to do with the recommended and time-honored ways of ensuring compliance. According to Hand hygiene monitoring and feedback, these are the accepted way of ensuring that hands get washed:
- Direct observation by a trained observer is considered the 'gold standard.'
- Product measurement whereby you measure how much soap or alcohol-based-sanitizer as well as paper towels are used per patient day
- Surveys allow you to gather information from patients and healthcare workers to assess perceptions and attitudes about hand-washing.
>> See 5 Hand Hygiene Observation Tools for additional observation tool resources.
That said, you can immediately sense the challenges and shortcomings associated with these compliance methods.
Direct observation is expensive and resource-intensive. It complicates patient care not to mention that it can affect patient privacy. The Hawthorne Effect is more likely than permanent behavior change.
Product measurement is inexact and difficult to specifically associate with individual workers.
Surveys bring in outside perspectives, but they measure perceptions rather than reality. And, they don't happen in the moment.
Finally, you'll need to use multiple methods to validate your results.
BTW, May 5 is World Hand Hygiene Day. Access the CDC Clean Hands Count Campaign Materials
Isn't it Time for Hand Washing to Meet Technology?
Even if mobile apps replace pen, paper and clipboards for monitoring hand hygiene, they still assume recording and observation from a third-party and/or after-the-fact.
Imagine instead a means for in-the-moment recording and real-time notification happening in the background and capturing enough data to get to root causes and truly determine how to affect behavior. Wouldn't that make for cleaner hands?
Hand Hygiene Compliance Monitoring Provides Benefits, Challenges suggests just such an approach:
"A newer type of hand hygiene compliance system is automated or electronic monitoring.
These indirect monitoring systems offer superior data collection by allowing continuous 24/7 monitoring leading to a larger sample size with thousands of data points, as well as automatic data download from the Web via Wi-Fi, and data analysis, and can be used to monitor trends in consumption over time, daily patterns, and use by type of care unit.(47-49)
In addition, these systems are unobtrusive, the Hawthorne effect is significantly mitigated, and required human resources are minimal."
Modern Healthcare refers to Sensors helping hospitals keep track of hand-hygiene performance, documenting impressive compliance improvements:
"Before implementing SwipeSense, the four Ballad hospitals that now use the system averaged roughly 100 to 200 instances a month per facility of monitoring whether or not someone washed their hands; Ballad relied on a mix of infection preventionists and so-called “secret shoppers,” or staff who agreed to secretly record observations.
That figure climbed to 100,000 to 400,000 with the automated systems."
In another example described in Denver hospital deploys hand hygiene monitoring system to boost adherence, the results are equally impessive:
"Denver Health Medical Center has gotten on top of the problem by implementing automated location monitoring technology to help boost hand hygiene adherence, a variable the Joint Commission recognizes is the most important way to prevent hospital-acquired infection transmissions.
Since implementation of the technology two years ago, baseline hand hygiene adherence rates at Denver Health jumped from about 40 percent to a sustained rate of more than 70 percent, according to hospital officials."
In other words, RTLS truly goes beyond hospital asset tracking!
Hand Hygiene and Data Analytics
Let's look at how data analytics can help bring about better hand hygiene in healthcare facilities.
Step 1 - Nurse enters patient room without washing hands.
Step 2 - Failure of this nurse to use the dispenser is logged (identity known via RTLS badge).
Step 3 - Once in the room, the RTLS badge beeps within 'x' seconds to remind the nurse to wash his/her hands.
Step 4 - Nurse uses soap dispenser; beeping stops.
Step 5 - Nurse gives meds and repositions patient in bed.
Step 6 - Nurse leaves the room without using the soap dispenser.
Step 7 - Failure to use the dispenser is logged.
Step 8 - The RTLS badge beeps to remind the nurse to wash.
Step 9 - Time until use of a dispenser by this nurse is logged.
The system enables real time tracking and hand hygiene compliance via RTLS, thereby controlling the spread of disease and minimizing the number of healthcare associated infections.
Finally, a dashboard logs all staff hand hygiene compliance showing status in red green and red. Depending on your hospital, you could even set up programs that reward compliance above 98%.
How Do You Empower Better Hand Hygiene in Your Healthcare Facility?
Hand washing compliance matters to all healthcare facilities. How do you monitor it in your organization? Have you considered implementing technology solutions such as RTLS? Or, are you more successful with systems such as direct observation?
Let us know in the comments.
Thanks for reading!
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