Healthcare Hygiene magazine January 2020 | Page 36

hand hygiene By Paul Alper Electronic Monitoring Systems: Essential Considerations In my October column I said the following about electronic monitoring: “While a nascent category that is still in the early adopter phase, the migration from human direct observation or secret shoppers, to validated, automated, systems that constantly measure healthcare worker performance is here to stay. The scientific evidence is becoming clear that the future “gold standard” will be the combination of direct observation (DO) as a “coaching and obstacle identification tool” with electronic monitoring as the “measurement tool.” I thought it might make sense to follow that column up with a checklist of essential consideration” should you and your organization decide to consider potential adoption in the near future and need a framework to create an RFP. While there are systems with many more features to consider, these are the ones that are most important to think about. For some, you will have to choose between options based on what would best suit your organization’s culture and your budget. Of course, whatever system you consider, there should be published outcomes evidence in support of adoption: ➊ Numerator capture (how many hand hygiene events actually occurred). The system must aggregate both soap and sanitizer hand hygiene events into an accurate numerator with a minimum 98 percent validated capture. ➋ Denominator calculation (how many hand hygiene events should have occurred). You must choose: does the system base its hand hygiene rate on a) IN and OUT hand hygiene or b) Or the WHO 5 Moments for Hand Hygiene? In either case, you will want to see evidence on how the denominator is calculated and how it has been validated. ➌ Reporting level. You will have to choose – does the system base its reporting on a) group/unit/department level hand hygiene rates or b) Individual healthcare worker hand hygiene rates? ➍ Report/dashboard access. The system should provide intuitive, unambiguous reports and dashboards both via direct system access (such as by logging on to the system) and also via “push” or automatically generated reports via email. ➎ C. diff room reporting. The system should provide the ability to see both soap- and sanitizer-event trending so that real time feedback can be given to staff as to whether or not they are complying with the typical C. diff protocol -- the switch to soap and water hand hygiene from alcohol-based hand sanitizer which does not kill C. diff spores. ➏ Type of Infrastructure. You must choose: a) is the system exclusively dedicated to hand hygiene compliance measurement (aka a stand-alone infrastructure) or b) one that works like an application (APP) with a new or previously installed real-time locating system (RTLS) infrastructure. RTLS 36 systems will typically support multiple APPs such as nurse call, workflow assessment, people and equipment tracking etc. If you do go with option b, you will want to explore the level of hand hygiene expertise on the part of the RTLS/APP provider to be sure you’re comfortable that they have the requisite capability needed to support your organization’s enterprise-wide adoption. ➐ Behavior change support. Successful outcomes (for example sustainable compliance improvement, culture change and reduced infections) are going to be very much dependent on how you approach changing your culture from one that relies on direct observation for measurement (with its typical overstatement of real compliance rates by up to 300 percent) to one that relies on virtually real time data that will likely reveal a 30 percent to 40 percent compliance range when you first implement it. You will want to verify that the system under consideration a) provides an evidence based behavior change framework, b) supports “psychological safety” – the ability for anyone to speak up in a professional and appropriate manner to colleagues (peers, superiors and subordinates) when hand hygiene does not occur when it should have and c) uses a positive and pro-active approach to dealing with data denial – this is the attitude by some on staff who will take the position that “my behavior is fine, it’s the data/system that’s inaccurate.” ➑ Reminders to perform hand hygiene at the point of care. You will have to decide if this a “must have,” “nice to have,” or “doesn’t matter to us” feature. This is accomplished, for example and depending on the system, by lights on the badge or dispenser, badge vibrations or by a voice reminder at the dispenser. While I think there will be some exciting next-generation technologies introduced over the next couple of years that will leapfrog the current generation in terms of new and important features, accuracy, reliability, evidence in support of adoption and lower cost, I hope this proves helpful. Let me know what you think and please send me your specific hand hygiene challenges, frustrations and nagging problems – I’ll share ideas that might be of interest in this monthly column [email protected]. Connect with me on LinkedIn.  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 vice president of patient safety Innovation for Medline Industries, Inc. through an exclusive engagement with his consulting practice, Next Level Strategies, LLC. january 2020 • www.healthcarehygienemagazine.com