hand hygiene
By Paul Alper
Is the Juice Worth the Squeeze ? Studies That Support Adoption of Electronic Monitoring Systems for Hand Hygiene
2021 may turn out to be a watershed year for hand hygiene ( HH ). The emergence of COVID-19 infections has created an ultra-heightened awareness of the importance of handwashing . Then there were the 2021 changes in the Leapfrog HH Standard 1 requiring up to 200 direct observations per unit per month or the use of a validated electronic monitoring system to achieve the standard on the way to a top Leapfrog Safety Grade and eligibility for Leapfrog ’ s Top Hospitals Award . These events among other drivers have led many healthcare organizations to evaluate electronic hand hygiene compliance monitoring systems ( EHHCMS ) to accurately and reliably measure HH compliance .
Naturally , this leads to the key question being asked by C-suite leadership : “ Is the juice worth the squeeze ?” To answer that question , we can turn to six studies published over the past seven years . By no means is this a meta-analysis of all studies but a sound cross-section of the available research . I hope it will help infection preventionists and quality leaders answer that return on investment ( ROI ) question when seeking funding for an EHHCMS . We all want to improve staff HH performance , as we know this will reduce the risk of avoidable harm and healthcare-acquired infections ( HAIs ), enhance patient safety culture and eliminate incremental costs associated with HAIs . For a comprehensive look at all research in the category of EHHCMS , turn to
PubMed .
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1Srigley , et al . ( 2014 ). “ Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system ” 3
This interesting study demonstrated how the Hawthorne Effect confounds the accuracy of direct observation ( DO ) as a means to measure HH compliance . A real-time tracking system was used to determine if a healthcare worker was in the line of sight of an observer conducting HH audits . When the healthcare workers could see the observer , they were about three times more likely ( 90 percent compliant ) to perform HH compared to when they could not see them ( 30 percent compliant ) -- a Hawthorne effect of 300 percent . The study was conducted in Toronto where HH rates are reported publicly and this overstatement of HH compliance was reported by the Toronto Star with the headline , “ Ontario hospital staff not washing hands as often as reported .” 4
One of the investigators , Dr . Michael Gardam , then the Toronto University Health Network ’ s director of infection prevention and control , is quoted in the Toronto Star as saying , “ We ’ re fooling ourselves . The numbers that we are getting and we are posting publicly are not real , they ’ re artificial .”
Kelly , et al . ( 2016 ). Electronic hand hygiene monitoring as a
2 tool for reducing healthcare-associated methicillin-resistant Staphylococcus aureus infection 5
Dr . William Kelly and colleagues at the Greenville Memorial Hospital in Greenville , S . C . ( now part of the Prisma Health System ) used an EHHCMS to demonstrate on a unit-by-unit basis that staff feedback based on data from the system was able to improve HH compliance by more than 25 percent . This was associated with a reduction in MRSA infections of more than 42 percent and a cost avoidance by eliminating 24 MRSA infections of $ 434,000 per year , or $ 670 per bed per year . Kelly further pointed out that , “ We show that electronic monitoring of HH can lead to clinically important organizational change and , most importantly , improved patient safety .”
Bouk , et al . ( 2016 ). Use of an Electronic Hand Hygiene
3 Compliance System to Improve Hand Hygiene , Reduce MRSA , and Improve Financial Performance 6
Martha Bouk , then head of infection prevention at Riverside Medical Center in Kankakee , Ill . used an EHHMS to also achieve improvement on three metrics : HH compliance ( 39 percent improvement ), reduced MRSA infections ( by 50 percent ) and improved economics ( their ACA financial penalty was eliminated ; multiple factors in addition to HH likely contributed to this ).
Robinson , et al . ( 2014 ). Innovative Use of Electronic Hand
4 Hygiene Monitoring to Control a Clostridium Difficile Cluster on a Hematopoietic Stem Cell Transplant Unit . 7
Natasha Robinson , then an infection preventionist at the Greenville Memorial Health System in Greenville , S . C ., used data from an EHHCMS to provide staff feedback on HH behavior to drive higher compliance with the facility ’ s protocol of washing with soap and water versus using alcohol-based hand sanitizer in the case of Clostridium difficile infections ( CDI ). The result was an increase in HH compliance to 93.9 percent from 77.4 percent ( 21.3 percent increase ) and a drop in the CDI rate from 7.03 / 10,000 patient days to 2.38 / 10,000 patient days -- a decline of 66 percent .
Banks and Phillips , 2021 . Evaluating the effect of automated
5 hand hygiene technology on compliance and C . difficile rates in a long-term acute care hospital . 8
Maureen Banks and Andrew Phillips demonstrated a significant increase in HH compliance from 89.7 percent to 97.1 percent and a reduction in CDI rates from 9.54 to 3.72 infections per 10,000 patient days ( 61 percent decrease ) in a long-term care acute hospital using an EHHCMS .
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Kelly et al , 2016 . Use of Targeted Solutions Tool ( TST ) and Electronic Monitoring to Improve Hand Hygiene
Compliance ( 2016 ) 9 Kelly and his team demonstrated a 23.5 percent improvement in HH using the combination of an EHHCMS for measurement