hand hygiene
hand hygiene
By Robert Lee
Hand Hygiene Compliance : A Common Sense Approach
We have all heard that hand hygiene is the most effective intervention to prevent both infection and the dissemination of potential pathogens to other patients and the healthcare environment . Hand hygiene is not simply washing and / or sanitizing your hands , but it is a conscious , intentional effort , knowing where , when , and how to maintain safe , pathogen-free hands .
While attending the 2024 HIMSS and AORN annual meetings , I had the opportunity to interview a number of individuals from the technology , data and clinical sectors to attain their perspective on hand hygiene . Three issues emerged from these conversations :
➊ Hand hygiene has once again been pushed to the back of the line as a prevention priority
➋ Hand hygiene compliance remains an elusive target
➌ The standard for hand hygiene compliance is a minimal standard
As one technology executive noted , “ The market only wants a minimum standard . Just checking the box is acceptable . We are looking at return on investment ( ROI ), not healthcare-associated infection ( HAI ) reduction .”
So , what is hand hygiene compliance and why is the bar set so low ? Reports of compliance at different sites vary from 15 percent to 95 percent . What level of compliance will allow your unit to operate safely , pathogen-free and decrease the incidence of HAIs ? One chief medical officer said , “ If hand hygiene compliance is measured properly , could 70 percent be the optimal , efficient and cost-effective metric for our staff ?” Compliance is establishing a process , adhering to that process , and measuring adherence to that standard . HAI is the measurement of your established workflow in digital terms , expressed as a fraction , the denominator total identified opportunities and the numerator the actual observed hand hygiene events , usually calculated and reported as a percentage .
Observed hand hygiene events _____________________
Total hand hygiene opportunities
Total hand hygiene compliance (%)
Total hand hygiene opportunities ( denominator ) includes touch points in the workflow where hands come in contact with personnel or objects in the environment . Examples include but are not limited to charts , IVs , cell phones , tablets , workstations , doorknobs , patients , etc ., anything that might harbor pathogens . This applies whether a healthcare worker is or is not wearing gloves .
Observed hand hygiene events completed ( numerator ) is the number of events where hand hygiene is indicated / required and successfully completed .
What are the challenges associated with calculating hand hygiene compliance ?
➊ Hand hygiene science and hand hygiene compliance may differ from unit to unit , care team and / or workflow .
➋ Measuring hand hygiene compliance with an entry-exit process does not consider activities and potential pathogen hand contact that occurs inside the patient care space after entry hand hygiene .
➌ Some institutions state they measure hand hygiene compliance during patient care , including contact with the surrounding care space but actually only measure entry and exit .
➍ Many institutions state they do not have the ability to measure hand hygiene compliance inside the patient care space .
➎ Many institutions do not clearly understand their workflow and have not standardized it using Lean / 6 Sigma principles ( denominator ).
➏ Many institutions indicate they just check the box and accept a minimal standard .
Questions to consider regarding the effectiveness of your hand hygiene compliance program : Do you know what you are measuring ? Are you measuring the correct components of hand hygiene ? Are you just conforming to minimal standards and checking the box ?
Hand hygiene is a science , defining how the hands of healthcare personnel interact with the patient and their environment during daily patient care . As I have noted previously , pathogens do not have legs , we give them legs . Understanding how pathogens move , providing barriers to mobility by appropriate hand hygiene at the correct time and place , coupled with excellent surface and environmental disinfection , will move the needle to decrease HAIs and antibiotic resistance . A common sense roadmap :
● Understand your workflow
● Workflows differ by unit / department / provider
● Design the most efficient workflow to allow your staff to provide optimal care
● Identify the key hand hygiene touchpoints in your workflow
● Ensure your dispenser infrastructure is as close to these touch points as possible
● Design your hand hygiene process based on current guideline ( 5 Moments ) and common sense
● Ensure your process addresses both gloved and ungloved hands
● Train / educate / reinforce specifically to your defined workflow and hand hygiene protocols
● Utilize your simulation center if available
● Measure performance and report as close to real-time as possible
● Design a certification program that defines performance standards for each unit
Currently , the science of hand hygiene education and training is suboptimal and too general . Staff do not have time to think about when , where and how to perform hand hygiene . It must be ingrained , become habit and be a conscious activity .
Please don ’ t hesitate to reach out to our team at THE IPEX ( The Infection Prevention Exchange ) for any questions or guidance at medicaldatamanagement @ gmail . com
Robert Lee , BA , the CEO and founder of MD-Medical Data Quality & Safety Advisors , LLC , is the senior biologist and performance improvement consultant . MD-MDQSA is the home of The IPEX - The Infection Prevention Exchange , a digital collaboration between selected evidence-based solutions that use big data , technology , and AI to reduce risk of HAIs .
24 • www . healthcarehygienemagazine . com • april 2024