hand hygiene
hand hygiene
By Robert P . Lee
How Effective and Accurate is Your Hand Hygiene Technology ?
Hand hygiene ( HH ) technology is an electronic data collection system that captures , organizes and reports data from healthcare workers and as they perform their daily patient-care tasks . It automates the process often performed by trained specialists , known as " secret shoppers ." These individuals are not enough . Experts indicate that one major limitation to monitoring compliance is HH data collection .
Traditionally , secret shoppers observe healthcare professionals and document how often they clean their hands going into and out of patient rooms . These observations miss many hand hygiene opportunities inside the room , and it ’ s a labor-intensive project for what amounts to a limited number of observations . 1 When we are observed by others , our behavior and performance is often governed by the Hawthorne effect , 2 the principle of greater compliance with expected behaviors when we are monitored . Hence , this approach may , in some ways , compromise the accuracy of the secret-shopper mode of measuring HH compliance .
Insight into HH requires an understanding of HH workflow and the steps in patient care that require HH . Before pathogens reach the host / patient , there are many opportunities to decrease the transfer of these microorganisms to the patient and the patient ’ s environment . HH science involves both the transfer of pathogens to the patient / host or to the patient environment ( an example of this is high-touch surfaces ). If patients ’ rooms were completely pathogen-free , then entry / exit might be an effective method to prevent and measure HH , but unfortunately , we all realize this is not the case .
There are currently two schools of thought regarding monitoring HH with technology :
Patient-Centric Model
Most available technologies utilize “ entry / exit ” methodology , assessing HH compliance at room entry and exit . A question to consider : Does measuring HH at room at entry and exit provide the data required to determine an accurate assessment of your HH compliance ? Studies show that 70 percent of HH opportunities occur inside the room . 3 Technologies that employ entry / exit monitoring do not measure HH within patients ’ rooms , even though some may claim otherwise . In most cases entry / exit technology will have you assume that the entire patient room is enough to measure HH compliance , but after reading the Clack study , understanding how pathogens move and some common-sense biology , you should ask yourself the questions , “ Are we measuring the right thing ? How accurate is our data ? Do we have a tool that will help us move the needle on healthcare-acquired infections ?”
WHO Five Moments for Hand Hygiene
Several technologies actually attempt to measure the World Health Organization ( WHO )’ s Five Moments for Hand Hygiene approach by placing sensors at the patient ’ s bed and tracking entry and exit in and out of these patient zones . Most of these technologies are challenged by accuracy , interference and lack of precision in their measurement , rendering data that can be questionable . Additionally , they do not consider other sites and vectors where pathogens may reside and can be transferred to the patient / host by healthcare workers as a result of poor HH within the room . This approach may not provide an accurate assessment of HH compliance . Some examples might be where a healthcare worker sanitizes their hands at the doorway and proceeds to touch a surface in the patient room prior to touching the patient , such as a workstation , computer , tablet , cell phone , chart , doorknob , IV pole , over-bed table , hands of visitors , etc . Another example might be , not only before patient contact , after patient contact . Does the healthcare worker go back and forth within the patient room during the care of the patient , touching items and not sanitizing their hands ? Does HH need to be performed ? Would you want to capture this data ? Would you want to know if the healthcare worker is performing HH and that they are assisted with technology to remind them to perform HH between these transactions ?
Key takeaways include :
• Understand what you want to measure
• Conduct a Lean 6 Sigma audit of your workflow , processes , protocols ( current state )
• Develop your optimal design based on science , biology and common sense ( future state )
• HH is not a single activity but a series of complex workflow activities
• Technology can enhance and help to sustain HH compliance
• Technologies vary in their capacity to accurately measure and acquire HH compliance data
• Some technologies may allow a more patient-centric approach to HH
• Not just entry and exit , but patient contact inside the patient ’ s environment
• Potentially capture data in real time 24 / 7
• Sufficient and accurate data to meet and exceed ( desired ) your accrediting regulatory requirements
Remember , “ zero ” is attainable , achievable and our duty to do no harm .
If you have any questions or needs , you can always reach out to me directly medicaldatamanagement @ gmail . com
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 . https :// edhub . ama-assn . org / cdc-project-firstline / pages / 5-hand-hygienechallenges
2 . Hawthorne effect . ( 2024 , September 30 ). In Wikipedia . https :// en . wikipedia . org / wiki / Hawthorne _ effect
3 . Clack L , Scotoni M , Wolfensberger A . et al . First-person view of pathogen transmission and hand hygiene – use of a new head-mounted video capture and coding tool . Antimicrob Resist Infect Control . 6 , 108 ( 2017 ). https :// doi . org / 10.1186 / s13756-017-0267-z
22 • www . healthcarehygienemagazine . com • november 2024