Healthcare Hygiene magazine December 2019 | Page 22

specific service, then an intensive education intervention may pay
off—if you include the service head, and make it clear that the
head is a partner in this process who will be accountable for their
team’s performance. The issue may be due to poor infrastructure.
For example, if hand gel stations or sinks are not accessible at
point of care, then we can hardly blame healthcare workers for
imperfect compliance. Plumbing, not education, would be the
solution. Finally, a common issue is just good old complacency.
For instance, you may find that a team performs perfect hand
hygiene 95 percent of the time. That’s pretty good, but there’s
still room for improvement. Everyone is human, and humans do
make mistakes! In my own practice, I model hand hygiene for the
trainees under my supervision, but I am humble about my own
failings, and challenge the fellows and residents to call me out if
they see me fail to perform hand hygiene: A free latte for each
trainee who catches me! The point is, getting your program to the
next level will probably require different interventions, depending
on the source of the gap. Talking to people and watching their
behavior always pays off.”
“If hand hygiene is performed as recommended, then it is an
extremely effective infection prevention measure,” emphasizes
Claudette Poole, MD, assistant professor in pediatric infectious
diseases and associate fellowship program director for infectious
disease at Children’s of Alabama. “The challenge, however, is
incorporating the behavior into the routine course of healthcare,
which becomes increasingly challenging as the complexity of
care increases. I think it is extremely helpful to have independent
observers, and ideally experts in human behavior to evaluate how
physical spaces are set up, and the physical steps required during
care encounters. It can be extremely enlightening to realize that
Expert
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She currently provides marketing and clinical consultation
to select industry partners who seek to support infection
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Learn more about her services at: www.zeroinfections.org
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many healthcare delivery spaces are not set up well, and
actually make it harder rather than easier for healthcare
providers to be compliant.”
Making it easier for healthcare professionals to do the
right thing when it comes to hand hygiene compliance
has been touted as the go-to practice by experts.
“There is no substitute for customizing interventions
to suit the particular needs of particular groups,” says
Pottinger. “As long as healthcare workers have a chance
to share their perspectives and so long as infection
control takes those conversations into account, you will
make progress. On the other hand, we risk failure when
we superimpose solutions onto providers without their
participation in the process.”
Pittet suggests that making hand hygiene easier entails
“Having alcohol-based handrub available at each patient’s
bedside and making people understand the importance
of their compliance. Measure compliance using the WHO
5 moments, motivate the workforce, make sure there is
sufficient training available. Behavior change is an ongoing
process, one is never done teaching, giving monitoring
feedback, or motivating people.”
Myriad monitoring interventions exist, with advantages
and drawbacks to each, and institutions must determine
for themselves what works best to boost compliance.
“At my center, we use a combination of direct
observation and secret shopper observation, with all
data logged via a proprietary app entered on a mobile
device,” says Pottinger. “Regardless of which system is in
place at a given location or time, one of the challenges
we face should feel familiar to everyone: If observers
are stationed in the hallway, they may lack information
about compliance with hand hygiene opportunities in
the patient room itself. I don’t have an easy solution for
this, because putting observers in patient rooms is often
impossible, or inappropriate, but it is an opportunity for
improvement, because so many ‘hand hygiene moments’
happen right at the bedside, and we may miss them.”
Pittet asserts, “The gold standard is still direct
observation. In our hospital we let the healthcare workers
know we are observing them, and we provide direct
feedback after the monitoring. That way the monitoring
is positive and an opportunity for learning, not punitive.
Although compliance may seem higher when healthcare
workers know they are being watched, the important
thing is changing their behavior, not making sure that
the number for hand hygiene compliance is perfectly
accurate. It is more important to improve than to hit a
specific target.”
Pittet continues, “There is a lot of potential for
electronic monitoring systems, but at this time there
are none that can measure the WHEN of the handrub
(the WHO 5 moments). If one day a system can measure
these five moments, it will be a revolution in hand
hygiene. For now, direct observation with validated
observers that give feedback directly to the healthcare
worker in a confidential way is the most effective way
of monitoring that we have found. It is important that
people feel like they are being supported by their IP&C
teams instead of policed.”
december 2019 • www.healthcarehygienemagazine.com