hand hygiene
By Robert Lee
Hand Hygiene in Surgical Services : Why Not a Digital Approach ?
This article is designed to catalyze some creative thinking around one of the most important areas of a hospital , the operative space , which includes pre-op , perioperative , post-op , and ancillary / support areas within the operating room ( OR ).
Here are some questions that need to be asked :
➊ Do you measure hand hygiene ( HH ) compliance in the OR ?
➋ What methodology do you follow : CDC , WHO , or a hybrid model ?
➌ Is your methodology measured manually ( secret shopper ) or automated ( technology )?
➍ What is your overall HH compliance for your OR ?
➎ What is your HH compliance for pre-op , post-op , OR suite , and other areas ?
➏ Does each staff member have a HH compliance scorecard and compliance score ?
➐ What is included in your HH training and education ? How often does it occur ? Do you assess competency ?
➑ Do you have a simulation center ? Do you utilize it for your HH training / education ?
➒ Do you support The Leapfrog Group and its HH guidelines , becoming part of the total hospital grade ?
➓ Do you know your Leapfrog Group quality grade ?
These are some questions that occurred after observation and review of HH and environmental services ( EVS ) compliance data for the perioperative areas :
➊ Why is hand HH performance different in pre-op and post-op areas versus main OR suites ?
➋ Is there less attention , or more lenient guidelines regarding HH in the perioperative areas ?
➌ Are there different standards for environmental cleaning inside and outside of the OR suite ?
➍ Why is sterile technique not standard of care both inside and outside the OR suite ?
➎ How accurate / reliable is your HH compliance and environmental services performance data ?
➏ Does the Hawthorne Effect contribute to your concern ?
➐ Have you considered a quality command center approach for your OR ?
How do you begin the process ?
Use a Lean 6 Sigma process to define the current state / workflow . Then , with the help of technology , collect data around this workflow . With consequent accurate , robust , and actionable data , one can then measure , benchmark and report individual , group and unit performance .
How to choose a technology ?
There are HH technologies available for the perioperative space that can accommodate an open-architecture design and support the WHO 5 Moments methodology . Open architecture designs present a challenge because high-touch surfaces are not contained only in a room , but they include stretcher bays , cubicles , incubators , etc ., typically found in recovery areas , emergency departments , dialysis units , etc . Most technologies only measure HH compliance at the entry / exit to a closed architecture , typically a room with walls . Can the technology capture data between patient and high-touch areas such as keyboards , workstations , and others as indicated by the WHO 5 Moments recommendation ?
As The Leapfrog Group recommends , assess the accuracy of your HH model and method of measurement of HH compliance . Ask your vendor for peer-reviewed , validated clinical studies that define the accuracy of their technology . Additionally , self-validate using observation . Ask yourself the question , “ Are we measuring the right things ?” With this baseline data , you can objectively assess your HH status and consider improvement with more accurate measurement , enhanced training , and serial measurement to improve your HH performance .
Technology is key to sustainability , easing required personnel and cost of measurement while markedly improving HH observations to accurately assess compliance . When technology is removed , compliance falls below starting levels .
An often-neglected consideration in decreasing hospital infections is the importance of environmental services . Improved hand hygiene performance can be significantly compromised if surfaces and high-touch areas do not receive appropriate decontamination . Decreased bioburden on surfaces and clean hands work synergistically to prevent pathogen transmission .
The Society for Healthcare Epidemiology of America ( SHEA ) recommends simultaneous interventions to prevent hospital-acquired infections . Similar to HH , technology can be a significant asset to monitor and enhance success in environmental decontamination .
With more than 100,000 deaths in acute-care sites and 400,000 deaths in alternate sites , hospital infections remain a serious problem that requires sustained effort to address and improve this problem . The recent pandemic has enhanced the visibility of this issue and emphasized the impact of inadequate adherence to established methods of pathogen transmission .
Until we “ follow the science ” with accurate , robust , real-time data , there will be the continued morbidity and mortality associated with preventable hospital infections . We have the tools and the knowledge , but we have yet to apply them effectively
President John F . Kennedy highlights what our mindset should be : “ We choose to go to the moon , not because it is easy , but because it is hard .” Is it time that all operating room leaders commit to “ going to the moon ”?
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 .