hand hygiene
By Paul Alper
Making the Business Case for Infection Control Technology
When I lecture infection preventionists on the latest approaches to optimizing hand hygiene performance , I typically open with a question , “ Are you responsible for driving hand hygiene compliance improvement ?” Usually everyone answers “ yes .” My follow-up gets the opposite response : “ Do you have a discretionary budget and authority to spend it on a vetted technology , product or service you feel will help drive sustainable improvement in compliance ?” Usually no one answers to the affirmative . This leads me to conclude that improvements in hand hygiene compliance require very sound arguments to convince leadership to allocate precious organizational resources . Here is a strategic framework to help you make the case for technology adoption and influence organizational leadership to buy in :
A . Be sure you can align your request with organizational priorities , keeping your eye on the best interests of the organization ’ s community-at-large
• Is patient safety , high reliability , getting to zero harm a stated organizational goal ? If yes , then align your request with how adoption will support and drive success with these organizational goals .
• How will adoption address obstacles to the ideal future state ? Create a vision for achieving the ideal state as the end game that adoption will help realize .
B . Identify all clinical and economic key influencers / decision- making stakeholders and know what is important to them .
• Target each with simple messages that define how their interests will be served .
• Listen to any barriers / obstacles they raise and collaborate to remove or mitigate them to acceptable levels .
C . It ’ s all about the math
• Get the evidence and math right . The following three-step process will help you do that . 1 . Know your baseline : what are you doing today and what does it really cost ?
Assuming you are doing direct observation ( DO ), you can calculate the true cost of DO based on the evidence based calculation as published in my March column . Using the 383-bed teaching hospital as an example , the total cost for DO for inpatient units was $ 117,914 per year .
2 . Calculate the cost for the technology . Let ’ s say the one you ’ re looking at costs $ 300 per bed per year on a subscription basis ; that comes out to $ 114,900 per year ( plug in whatever number applies to the technology you are considering ; include all costs including any costs for badges , maintenance , repair and battery replacement , if any ).
3 . Make a sound assumption for what the impact on HAIs will be and calculate the ROI . Let ’ s look at two examples where electronic hand hygiene systems were implemented and had a positive impact on MRSA and C . diff rates , as these are infections known to be easily transmitted by the hands . Kelly , et al . 2 showed a 43 percent reduction in MRSA infections and estimated each avoided infection saved the hospital $ 18,083 . In this instance , the savings amounted to $ 434,000 , or $ 670 per bed per year . Robinson , et al . 3 showed a 66 percent
reduction in the rate of C . diff but did not do any economic impact analysis . Zhang , et al . 4 estimate the incremental cost of a C . diff infection to be $ 25,000 .
Eliminating just one MRSA and one C . diff infection could save more than $ 43,000 per year . Eliminating two of each would save more than $ 86,000 . Using the data from the Kelly and Robinson studies as conservative baselines , how many MRSA and C . diff infections could you avoid by implementing an electronic hand hygiene compliance system ( or any innovative technology for which you wish to make the business case )? Here is an example assuming just two MRSA and one C . diff infections are eliminated ( cost avoidance = $ 61,166 per year ):
Calculate the ROI dollars . For this example ( set up in EXCEL for ease of use ):
a ) Technology Cost Plug in annual cost of your contemplated technology here = $ 114,900
b ) Cost of DO saved Plug in current total annual cost of Direct Observation here = $ 117,914
c ) HAI costs avoided Plug in your estimated annual HAI impact savings here = $ 66,166
ROI ( savings per year )= a-b-c
Calculate a-b-c to calculate your ROI ( savings per year here ) which should be a negative number as it represents savings = ($ 69,180 )
Then , be sure to add in the additional operational benefits , if any , of the technology you are advocating for , such as provides accurate data ; enables feedback to frontline staff ; capable of real-time reminders at the point of care to prevent possible missed hand hygiene opportunities ; supports our high reliability organizational goals ; supports an enriched patient safety culture , etc .
No matter what technology or solution you are considering , this method for influencing leadership with a well document ed business case supported by the science , will help you strategically frame your request in a sound , evidence-led manner consistent with a value-driven , high-reliability organization .
Paul Alper , BA , is the vice president of patient safety innovation for Medline Industries , Inc . through an exclusive engagement with his consulting practice , Next Level Strategies , LLC .
References :
1 . Srigley JA , et al . Quantification of the Hawthorne Effect in Hand Hygiene Compliance Monitoring Using an Electronic Monitoring System : a Retrospective Cohort Study . ( 2014 ) BMJ Qual Saf . 23 , 974-80 .
2 . Kelly JW , et al . Electronic Hand Hygiene Monitoring as a Tool for Reducing Health Care Associated Methicillin-Resistant Staphylococcus aureus Infection . ( 2016 ) Am J Infect Control . 44 ( 8 ), 956-957 .
3 . Robinson N , et al . Innovative Use of Electronic Hand Hygiene Monitoring to Control a Clostridium Difficile Cluster on a Hematopoietic Stem Cell Transplant Unit . ( 2014 ) Am J Infect Control . S29-S166 , S150 .
4 . Zhang D , et al . Attributable Healthcare Resource Utilization and Costs for Patients with Primary and Recurrent Clostridium difficile Infection in the United States . Clin Infect Dis 2018 .