hand hygiene
By Paul Alper
Calculating the True Cost of 200 Direct Observations Per Unit Per Month in 7 Steps
The purpose of the study was , for the first time , to determine hand hygiene opportunities ( HHOs ) in 2 types of hospitals - teaching and community within three clinical areas : medicalsurgical units , intensive care units and emergency departments .
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With the Leapfrog hand hygiene standard requiring 200 direct observations per unit per month for inpatient units ; up to 200 observations per month for emergency department units based on the number of visits per month and up to 200 observations per unit per month for areas where the monthly occupancy rate fluctuates 1 ( e . g ., PACU , outpatient units ), many healthcare organizations are trying to calculate real the costs of direct observation as required to meet the standard .
Fortunately , there is an evidence-based calculation for the true cost of those 2,400 visual observations per unit per year based on the HOW2 ( Hand Hygiene Opportunities Where and When ) Benchmark Study , 2 published in AJIC in 2011 .
The purpose of the study was , for the first time , to determine hand hygiene opportunities ( HHOs ) in 2 types of hospitals - teaching and community within three clinical areas : medical-surgical units , intensive care units and emergency departments . The study used trained direct observers , controlled for inter-rater reliability , to calculate the actual number of HHOs per patient day .
This column will focus on calculating the costs for in-patient areas . Because patient census in outpatient areas and emergency departments is so variable , we will use a conservative plus up factor estimate of 15 percent for these areas , but the data is there to do exact calculations based on your organizations actual statistics to gain that level of precision , should you wish to do so .
The study determined the number of HHOs in Adult Medical Units and ICUs ( Table 1 ). Note that the study looked for WHO 5 Moment total HHOs but also broke the data down by moment , so we can calculate that “ In and Out ” HHOs in and Adult Medical unit equals 48.9 percent of the total .
From here , we just need to know the true , fully loaded cost for the staff doing the observations along with the total number of units and average bed counts for each and we can then calculate the cost per year of meeting the 200 visual observations per unit per month .
The following calculations are based on two real hospitals , a teaching hospital and a community hospital . The bed counts and labor costs were provided by senior nursing leadership . The calculations were done based on the “ in and out ” standard for measuring hand hygiene , as most hospitals are unable to conduct accurate visual observations for the WHO 5 Moments .
The Teaching Hospital
There are 328 medical unit beds in 19 units with an average of 17.3 beds per medical unit . There are also 54 ICU beds in six units with an average of nine beds per ICU . Their average cost for their nursing staff direct observers is $ 42 per hour with benefits .
Here is the calculation which you can easily re-create for your organization :
Medical Units
Step 1 : Divide the HHOs per patient day of 35 by 24 to get the HHOs per patient hour , in this case = 1.5
Step 2 : Multiply that by the average number of beds per medical unit , in this case 17.3 , to get the HHOs per unit hour = 25.2 .
TABLE 1 - HHOs per Patient Day in Multiple Settings
Hospital Type |
WHO 5 Moment HHOs / Patient Day : Adult Medical Unit |
WHO 5 Moment HHOs / Patient Day : Adult ICU |
“ In and Out ” HHOs / Patient Day : Adult Medical Unit |
“ In and Out ” HHOs / Patient Day : Adult ICU |
Teaching Hospital
71.6 178.8 35.0 87.4
Community Hospital
30.3 70.9 14.8 34.7
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