hand hygiene
hand hygiene
By Robert P. Lee
Is Less Data Better Than More Data When It Comes to Hand Hygiene?
Data is the new currency in the marketplace, whether managing a business, fighting a war, flying an airplane, navigating a ship, going to space, or working in the healthcare environment. Just as DNA is the foundation of life, data is the critical component of our processes, whether simple or complex. At times, within the infection prevention arena, the importance of real time, robust and accurate data is minimized. Rationalizations proposed often include not cost effective, inefficient, too much work, or time could be better spent on education, training and culture. For discussion, I reference a recent study by Reese, et al.( 2024) who said their findings suggest hospitals could reduce hand hygiene( HH) observations to 50 per unit per month without affecting data quality even at lower adherence. It is recommended that standards shift focus from monitoring( with fewer observations) to training, education, culture, infrastructure, and feedback.” 1
This study suggests that healthcare facilities can reduce the number of HH observations from 200 or 100 to 50 and the quality of data regarding HH compliance is not significantly impacted. It should be noted that the World Health Organization( WHO) recommends 200 observations and the Centers for Disease Control and Prevention( CDC) recommends 20 observations. 2 Also, the Leapfrog Group indicated that its guideline was based on the more stringent WHO standard of 200.
There are important considerations regarding this recommendation. There may be no difference between 200 and 50 observations in evaluating changes from one point in time to another, i. e., a monitor of consistency. However, is it an accurate number to measure HH compliance according to the WHO? Should the number of data points actually be greater than 200? Why were 200 observations chosen as the point of comparison? A third consideration is the number of observations necessary to provide sufficient feedback for training and education to assure maximum compliance with HH standards. Are we limiting maximizing HH compliance and its consequent importance in decreasing HAI? 3
Our internal research has shown:
• During a typical shift, nurses may find the need to sanitize their hands over 200 times as opposed to WHO findings of 5 to 42 time / shift2
• HH compliance averages less than 30 percent as opposed to WHO / CDC findings( 38.7 %) 2
• HH compliance typically improves by 50 percent when technology is employed to monitor HH
• With improved HH compliance, healthcare-associated infections( HAI) are reduced, typically by 50 percent
• Typical data reported per day using technology is 20,000 to 40,000 HH observations
• Data is reported daily by individual, unit, department, facility and IDN
Here are some other questions: Can we have compliance and accountability without good data? And does the 20 / 100 / 200 observations represent 20 / 100 / 200 person or 20 / 100 / 200 unit? Can we train and educate without good data if we are measuring these few observations per unit? Can we become predictive versus reactionary without good data? How unprepared around data were we with COVID-19?
The Secret Shopper approach is not a favorite endeavor of infection preventionists( IPs) or those designated to support this activity. Typically, Secret Shoppers stand in an inconspicuous manner and location to observe and record HH compliance. In most instances, they do not enter the patient’ s room where 70 percent of HH opportunities occur. 4 Is 50, 100, or 200 an accurate measure of HH compliance and is data acquired from these numbers actionable?
From these questions, a consideration is HH technology; it may provide the HH data that provides the numbers actually required to accurately access HH compliance. It does not require observing personnel and records data both inside and outside the patient rooms with wearable recorders for all personnel. Is technology a solution for your facility, especially considering the preceding discussion? Using a return on investment( ROI) calculation, a trial at your institution could significantly improve the number of observations and a more accurate assessment of HH compliance, negating the calculation of 50 versus 200 observations.
Listed are five ideas to consider when assessing your HH program:
➊ Embrace the power of big data, technology and AI
➋ Because many technologies are portable, you can rent, lease or buy room modules and move between units as needed. Renting is a good way to meet your Leapfrog requirements without having to buy a full system.
➌ Learn how to cost justify hand hygiene technology
➍ Educate IP to enhance their access and voice with the facility’ s administration
➎ Use your performance improvement teams( Lean 6 Sigma)
If data is the new currency in the marketplace, automation, technology and AI are the future. With the cost of HAI more than $ 47 billion annually and HH one of the most effective methods to reduce HAI, it is unlikely that the cost of enhancing HH compliance and consequent reduction in HAI is unaffordable.
And as always, if you need help, please reach out to the IPEX team for assistance.
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.
References:
1. Reese SM, Knepper BC, Crapanzano-Sigafoos R. Right-sizing expectations for hand hygiene observation collection. Am J Infect Control. 2024 Dec 5: S0196- 6553( 24) 00857-5. doi: 10.1016 / j. ajic. 2024.11.017. Epub ahead of print. PMID: 39708046.
2. Who Guidelines of Hand Hygiene in Healthcare / First Global Patient Safety Challenge / Clean Care is Safer Care. https:// iris. who. int / bitstream / handle / 10665 / 44102 / 9789241597906 _ eng. pdf
3. LeapFrog Hospital Survey / Factsheet: Hand Hygiene. https:// ratings. leapfroggroup. org / sites / default / files / 2024-03 / 2024 % 20Hand % 20Hygiene % 20 Fact % 20Sheet. pdf
4. Clack L, Scotoni M, Wolfensberger A, Sax H.“ First-person view” of pathogen transmission and hand hygiene- use of a new head-mounted video capture and coding tool. Antimicrob Resist Infect Control. 2017 Oct 30; 6:108. doi: 10.1186 / s13756-017-0267-z. PMID: 29093812; PMCID: PMC5661930.
mar-apr 2025 • www. healthcarehygienemagazine. com •
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