Healthcare Hygiene magazine December 2019 | Página 23
If hand hygiene
is performed as
recommended,
then it is an extremely
effective infection
prevention measure.”
—
Monitoring and collecting
hand hygiene-compliance data is
a complicated task, compound-
ed by the necessity of making
sense of it and further using it
to improve compliance.
“In our practice, meaningful
data are detailed data: Instead
Claudette Poole, MD
of a unit-based percentage of
compliance, we provide service
chiefs with information about total number of observations
and the percent of compliant encounters based on job title,”
says Pottinger. “In this way, leaders can decide whether they
need to intervene with particular groups of providers. And, no
one escapes the view of our eagle-eyed observers! All workers
who enter and leave the room are subject to their scrutiny,
and the immediate, polite, friendly, supportive feedback of
our direct observers.”
“When data is collected on the 5 moments, one can
measure institutional compliance, compliance by ward, by type
of healthcare worker, and compliance by (WHO 5 moments)
moment,” Pittet says. “For example, if you notice that there
is much lower compliance before aseptic procedures, you
could do a training for hand hygiene specifically before aseptic
procedures. If you notice that hand hygiene is much worse in
the obstetrics ward, or among doctors, you could target that
population with trainings or other initiatives.) You can also
use this data to fill out the Hand Hygiene Self-Assessment
Framework, which will allow you to analyze your institution,
and see what elements your specific institution needs to
improve on. It also allows you to compare your institution to
others around the world.”
Poole cautions about monitoring: “Monitoring is not the
answer. All healthcare providers come to work every day with
the intention of doing the best for their patients. As institutions
we need to determine what is making it hard for providers to
comply. Are provisions sufficient and conveniently placed? Are
provider to patient ratios reasonable? Are we expecting too
many disparate tasks to be performed and are we providing
enough ancillary support?”
Poole continues, “Much has been written about the
inaccuracy of the current measures to collect hand hygiene
data. In its current forms I am not certain how helpful they are
in improving compliance. The most effective measures that have
been shown to work are design solutions and incorporation
of bundles. In general institutions that have an overall focus
on patient safety, infection prevention and performance
improvement where all levels from executive leadership to
housekeeping and ancillary staff share in that focus, will tend
to see a decrease in hospital-associated infections.”
References:
Ellingson K, Haas JP, et al. SHEA/IDSA Practice Recommendation: Strategies
to Prevent Healthcare-Associated Infections Through Hand Hygiene. Infect
Control Hosp Epidemiol. Vol. 35, No. S2. August 2014.
Pires D, Soule H, Bellissimo-Rodrigues F, de Kraker MEA and Pittet D.
Antibacterial efficacy of handrubbing for 15 versus 30 seconds: EN 1500-based
randomized experimental study with different loads of Staphylococcus aureus
and Escherichia coli. Clin Microbiol Infect. 2019 Jul;25(7):851-856.
Salmon S, Phua MY and Fisher D. One size does not fit all: the effectiveness
of messaging for hand hygiene compliance by profession in a tertiary hospital.
J Hosp Infect. Sept. 13, 2019.
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