This Chart illustrates the point :
TYPE OF UNIT / FACILITY
20 bed medical unit in a teaching hospital
TARGET DIRECT OBSERVATIONS PER UNIT PER MONTH
ESTIMATED NUMBER OF WHO 5 MOMENT HHOs PER UNIT PER MONTH BASED ON THE HOW2 STUDY FOR IN-PATIENT UNITS
200 42,960
10 bed ICU in a teaching hospital
200 53,640
20 bed medical unit in a small community acute care hospital
10 bed ICU in a small community acute care hospital
200 18,180
200 21,270
There are electronic monitoring systems available today that are capable of capturing virtually every HHO as well as HHEs , thus providing much more robust and actionable data . A 15- unit , 250 bed academic hospital would likely have an estimated 8.3 million total in-patient HHOs / year ( assuming 100 percent occupancy ; 200 medical unit beds and 50 ICU beds ) based on the HOW2 Study . This could be a great source of rich insights for front line staff feedback
The Economics of Direct Observation : The cost of meeting
5 the 200 direct observations per unit per month target for a 250-bed academic medical center with 10 medical units ( 20 beds each ) and 5 ICUs ( 10 beds each ) for in-patient monitoring alone could be over $ 76,000 / year assuming a total cost , with benefits , of $ 55 / hour for trained direct observers . This annual number would be significantly higher for a community hospital . There are electronic monitoring systems on the market with similar or lower costs per year that could provide much more timely , in-depth and actionable data .
When considering these factors and the goal of achieving 200 observations per unit per month , it becomes clear that , while either method can be used , direct observation has significant limitations while automated systems for monitoring hand hygiene compliance should be seriously considered for their robust clinical as well as economic benefits .
Disclosure : Medline is a 2021 member of the Leapfrog Partners Advisory Committee and has a collaborative relationship with a company that offers electronic hand hygiene monitoring services .
Paul Alper , BA , led the launch of PURELL ®, invented the first electronic hand hygiene monitoring system proven to reduce infections while improving behavior and eliminating costs and is now the VP Patient Safety Innovation for Medline Industries , Inc . through an exclusive engagement with his consulting practice , Next Level Strategies , LLC .
References :
1 . Kelly W , Blackhurst D , Steed C , Boeker S and McAtee W . Use of the Targeted Solutions Tool and Electronic Monitoring to Improve Hand Hygiene Compliance . Paper presented at the 2016 SHEA annual meeting .
2 . Son , C ., Chuck , T ., Childers , T ., Usiak , S ., Dowling , M ., Andiel , C ., Sepkowitz , K . ( 2011 ) Practically speaking : Rethinking hand hygiene improvement programs in health care settings . American Journal of Infection Control , 39 ( 9 ), 716 – 724 . doi : 10.1016 / j . ajic . 2010.12.008
3 . Boyce JM . Electronic Monitoring in Combination with Direct Observation as a Means to Significantly Improve Hand Hygiene Compliance . ( 2017 ) Am J Infect Control . 45 ( 5 ), 528-535 .
4 . Srigley JA , Furness CD , Baker GR and Gardam M . 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 .
5 . Dhar , et al . Observer bias in hand hygiene compliance reporting . ( 2010 ) Infec Contr Hosp Epidemiol ; 31 ( 8 ): 869-70
6 . Kelly JW , Blackhurst D , McAtee W and Steed C . 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 .
7 . Steed C , Kelly JW , Blackhurst DW , Boeker S , Diller T , Alper P . Hospital hand hygiene opportunities : where and when ( HOW2 )? The HOW2 benchmark study . ( 2011 ) Am J Infect Control ; 39:19-26 .
8 . Leapfrog Group . ( 2020 , April 13 ). Leapfrog Hospital Survey . Retrieved from https :// www . leapfroggroup . org / sites / default / files / Files / 2020HospitalSurvey _ 20200413 _ 8.1 % 20 % 28version % 201 % 29 . pdf
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When considering these factors and the goal of achieving 200 observations per unit per month , it becomes clear that , while either method can be used , direct observation has significant limitations while automated systems for monitoring hand hygiene compliance should be seriously considered for their robust clinical as well as economic benefits .
www . healthcarehygienemagazine . com • february 2021
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