Automated Hand Hygiene Monitoring

Every year in the U.S., more than 700,000 hospital patients contract an avoidable infection known as an HAI, or healthcare-associated infection. Of those patients, approximately 75,000 will die.1

At the same time, Medicare’s Hospital-Acquired Condition (HAC) Reduction Program has already penalized 721 hospitals in fiscal year 2015. Estimates project the total penalties to be approximately $373 million across U.S. hospitals.2

HAIs are a critical contributing factor to the penalty program, in particular MRSA and C. diff, which were added to the list for 2017.

Preventing HAIs at the Desk

On the front line in the fight against HAIs are infection preventionists (IP). While they have a complex set of responsibilities to ensure their hospitals are safe for patients and staff, a recent case study3 revealed that IPs spend over five hours a day collecting and reporting hospital infection data to federal health agencies. This leaves little time for their other crucial duties, including educating personnel about hand hygiene best practices and ensuring compliance at critical points of patient care.

Hand hygiene is a foundational component of a comprehensive infection prevention program, particularly vital during an influenza season, and high compliance rates can contribute significantly to reducing HAIs and increasing patient safety. The most commonly used method of collecting hand hygiene compliance data is direct observation. However, this method is highly regarded as unreliable due to the Hawthorne effect4, which results in inflated hand hygiene rates as clinicians clean their hands more frequently because they know they are being observed.

Additionally, it takes significant resources to implement direct observation: Staff or volunteers spend hours observing and manually recording their peers’ hand hygiene behavior. No matter how diligent they are, it is simply not possible for them to capture every hand hygiene moment, leaving millions of opportunities unobserved every year. The result is that hospitals invest a great deal of resources into direct observation and end up with an insignificant sample size and inherently flawed data.

SEE ALSO: Complying With the SEP-1 Bundle

Technology to the Rescue

Fortunately, modern technology makes many aspects of our lives easier, and hand hygiene compliance monitoring is no exception. Resources exist to eliminate the need for direct observation, saving IPs countless hours of observation and manual data recording.

Electronic hand hygiene compliance monitoring systems offer scientifically proven solutions for hospitals of all types and sizes, providing data in near real-time, and some reporting nearly identical compliance rates as 24-hour video monitoring.5

Hospitals can customize their monitoring systems based on the facility type and size, unit type, hourly patient census and nurse-to-patient ratio to get the most accurate data, while freeing time for IPs to dedicate to educating staff and protecting patients.

Compliance Monitoring Not Created Equal

When considering an electronic system to track hand hygiene compliance, consider these four factors to assure the system will deliver accurate, actionable results.

The technology must be based on scientifically validated methodology when calculating hand hygiene compliance. Some systems provide feedback on hand hygiene compliance rates based on the “in and out” method of washing hands. Others focus on the Five Moments for Hand Hygiene method as recommended by the World Health Organization (WHO).6

The Five Moments guidelines represent a higher clinical standard that facilities across the U.S. and Canada are implementing to enhance patient safety and infection control. The number of hand hygiene opportunities based on the Five Moments will be different from the number of opportunities reported by a system that monitors hand hygiene only before and after contact with a patient. In fact, by only following the “in and out” philosophy, healthcare workers are missing nearly half of all opportunities7, and arguably some of the most high-risk moments for transmission of bacteria (moments 2 and 3).

IPs will need to educate staff on the Five Moments method and explain the system methodology to set employee expectations for compliance rates in order to achieve best outcomes.

Another important factor to consider is whether the compliance system monitors both at the point-of-care and across the care continuum. The activity of the wall-mounted soap and sanitizer dispensers will need to be monitored as well as sanitizer pump bottles in the patient zones and other healthcare environments, such as outpatient facilities, long-term care areas, and ambulatory zones.

IPs need to evaluate the impact of an electronic monitoring system on staff activity. Once the system is installed, it should be easy to use without interrupting the staff’s clinical workflow.

Reports in real-time allow IPs to share accurate, timely feedback with staff to reward them for excellent performance or to remind the unit to use best hand hygiene practices. When the system is based on a group-based technology and tracks performance of a unit, not individuals, it encourages staff to work as a team to improve. This leads to transforming the culture of compliance to that of accountability and support, ultimately leading to an increase in hand hygiene compliance rates.

Cost vs. Value

HAIs are expensive, dangerous, and often fatal. Proper HAI reporting allows the facility to recognize infection control challenges within the facility and drives necessary improvements. As facilities continue adjusting to the value-based reimbursement model, an effective compliance monitoring technology is a must-have to help ensure a safe environment for patients and staff.

While the option of automating hand hygiene compliance monitoring is often overlooked by hospital leadership, and even IPs themselves, in the complex hospital environment, putting such technological advances to work results in multiple benefits. They include reducing the time needed to track, input and report hand hygiene compliance data; increasing IPs time away from their desk to educate patients and staff about infectious diseases; and driving up compliance rates by giving visibility to true performance data and making hand hygiene a daily priority for hospital staff.

1. HAI Prevalence Survey. Centers for Disease Control and Prevention. Last updated October 15, 2015. Accessed December 23, 2015.
2. Medicare cuts payments to 721 hospitals with highest rates of infections, injuries. December 20, 2014. Accessed December 23, 2015.
3. Infection preventionists may spend more time collecting data than protecting patients. Association for Professionals in Infection Control & Epidemiology Web site. Published June 25, 2015. Accessed December 18, 2015.
4. Haessler S, The Hawthorne effect in measurements of hand hygiene compliance: a definite problem, but also an opportunity. BMJ Qual Saf 2014. doi:10.1136/bmjqs-2014-003507.
5. Diller T, William Kelly J, Blackhurst Dawn, Steed Connie, et al. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: Validation of the HOW2 Benchmark Study. AJIC. 2014; 42(6): 602-607.
6. Five moments for hand hygiene. World Health Organization Web site. Accessed December 18, 2015.
7. Steed, Connie, William Kelly J, Blackhurst, Dawn, et al. Hospital Hand Hygiene Opportunities: Where and when (HOW2)? The HOW2 Benchmark Study. AJIC 2011; 39(1): 19-26.

Didier Bouton is president and CEO of DebMed North America.

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