hand hygiene
hand hygiene
By Robert Lee
Integrated Delivery Networks and Hand Hygiene Compliance
To decrease healthcareassociated infection ( HAI ), there should be consistency in hand hygiene goals , performance and outcome ( compliance ) to decrease the morbidity , mortality and cost associated with HAIs .
To reach these metrics there must be careful assessment of the differences upstream and downstream , as well as within individual departments in a single site .”
A healthcare Integrated Delivery Network ( IDN ) is an assemblage of healthcare providers , including both acute ( hospitals ) and non-acute care sites ( clinics , physician offices , surgery centers , long-term care , etc ). Supply chain systems and processes used in an acute-care hospital are not always effective in the non-acute care setting . Technology , workflow , supplies , information technology , data and skillsets of personnel can differ significantly . Two things are common to both sides of this equation , however : Cost and quality / safety ( infection prevention ).
A question to consider is why ? Within an IDN ( and even within individual hospitals ) are there various tiers of acuity and compliance with hand hygiene compliance ? Why are rules , or at least compliance with accepted standards , different for downstream ( non-acute care ) and upstream sites ( acute-care sites )? Even within an acute-care setting , rules and / or compliance may vary among different departments , such as the OR , OB , MedSurg and ICU . Assessing the differences in these individual departments would be an interesting exercise as , if infection prevention is everyone ’ s responsibility , one would expect the entire IDN to be consistent across all departments regarding infection prevention .
Observations during several consulting engagements assessing hand hygiene compliance provided some insight into these issues . In one setting , staff was observed working during the delivery of patient care , both from different sites on the ward as well as during patient-to-patient care . Gloves were commonly employed but often there was no hand hygiene performed during glove changes and often less-than-ideal hand hygiene compliance was observed . At a second major IDN in the central United States , physician , staff and patient-care workflow were assessed in an ambulatory setting . Hand hygiene technology was employed to track workflow during patient care for seven days , employing smart dispensers and smart ID badges to track hand hygiene compliance . The engagement resulted in restructuring of patient-care flow , but hand hygiene compliance for this 25-exam room physician clinic was less than 10 percent . At a large teaching hospital in the Southeast , our team measured hand hygiene compliance in the perioperative space . Despite the unit ’ s location contiguous to the OR , where hand hygiene and sterile technique are maximized , hand hygiene compliance was less than 17 percent . Finally , at a large IDN in the Southeast , consultation
IDNs need to standardize both upstream and downstream infection control guidelines and expected , as well as appropriately assessed and documented , compliance in this important patient and staff safety protocol .”
was requested to identify gaps in quality , focused on improving hand hygiene compliance and Leapfrog Group scores . The initial assessment suggested that this IDN would spend $ 100 million over the next five years to service their infections .
Returning to the question posed previously , why do the rules and compliance seem to differ upstream , downstream and inter-departmentally ? To decrease healthcare-associated infections ( HAIs ), there should be consistency in hand hygiene goals , performance and outcome ( compliance ) to decrease the morbidity , mortality and cost associated with HAIs . To reach these metrics there must be careful assessment of the differences existing upstream and downstream , as well as within individual departments in a single site . With this data , to enhance outcomes , there must be consideration of how we train , educate , and maintain appropriate and maximized hand hygiene compliance . Are our current rules and guidance sufficiently rigorous ? One consideration is to develop a training program where all personnel are certified each year via classroom , on the job and , where available , simulation training , with the last approach being the most effective mode to demonstrate in actual practice the skills critical to effective hand hygiene , to protect both patients and personnel and decrease HAIs Finally , IDNs need to standardize both upstream and downstream infection prevention and control guidelines , as well as appropriately assess and document compliance in this important patient and staff safety protocol .
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 . www . healthcarehygienemagazine . com • december 2023
25