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DebMed Blog: Healthcare Hygiene Matters

Reduce the Risk. Go All Hands In for Electronic Monitoring

Posted by DebMed on Mar 12, 2015 9:30:00 AM

This is the last of a five-part series that covered best practices for driving hand hygiene compliance. This blog zeroes in on the role of accurate monitoring and feedback to achieve optimal compliance.


From the flu, to methicillin-resistant Staphylococcus aureus (MRSA), and antimicrobial resistant diseases, there is a wide range of germs that are spread by un-cleaned or improperly cleaned hands. This unnecessary spreading of germs takes a significant toll on healthcare in terms of lives lost and increased costs.

But there is a seemingly obvious and relatively simple way to combat all of this. Increased hand hygiene supported by electronic monitoring. A study from Duke University Medical Center found that even a 5 percent increase in hand hygiene compliance can save a 200-bed hospital $198,250 each year through preventing infections. And a study from Greenville Health System in South Carolina has validated the accuracy of an electronic monitoring system for reporting compliance based on the WHO 5 Moments for Hand Hygiene.

As hospitals are looking for methods of tracking hand hygiene compliance that are cost-effective, easy to implement and readily accepted by staff, here are five points to keep in mind.

One: The Eyes Don’t Have It:   Direct observation of hand hygiene compliance has been proven to be unreliable through multiple studies due to the Hawthorne effect, which typically inflates compliance numbers. However, electronic monitoring has earned kudos from more than 80 percent of professionals.     

Two: Get Going with the Flow: The highest increased gains in hand hygiene compliance are seen when hand hygiene is integrated into the clinical workflow, as recommended in the World Health Organization’s (WHO) Five Moments for Hand Hygiene Compliance. The ideal hand hygiene compliance system records, measures, and reports hand hygiene behavior without disrupting or changing the clinical workflow. The bottom line: Hand hygiene works best in the context of caring for patients.

Three: After the Data Deluge: Professionals on the frontlines of patient care have little use for so called “Big Data.” Instead, they want accurate, timely, evidence-based data that allows them to make better, more informed decisions. Such data lets them know where they stand on hand hygiene compliance. How are various units performing? Is compliance higher on weekdays or weekends? Accurate and timely data is the first step in helping healthcare professionals make a decision on how, when and where to change or improve hand hygiene behavior.  

Four: On Point at the Point-of-Care: Question: Where are clinicians when they are delivering healthcare services directly to patients?  Answer: The point-of-care. Hand hygiene compliance soars when clinicians can easily clean their hands at the point-of-care within the patient zone, without having to step away to access a wall-mounted dispenser. Point-of-care hand hygiene is a position endorsed by the WHO, the CDC and the Joint Commission Center for Transforming Healthcare Lean Six Sigma Hand Hygiene Project. Look for hand hygiene monitoring systems that can monitor not just wall-mounted dispensers but also sanitizer pump bottles right at the point-of-care, including the NICU.

Five: It Takes a Village: While hand hygiene demands individual commitment, it’s also a team sport. Individuals can do much to build a team-based culture that supports hand hygiene compliance. That might include everything from huddles on hand hygiene data and coaching, to incentives and recognition of hand hygiene superstars. It also means not singling out individuals who are not doing well, which can be seen as punitive, but rather reporting on compliance at the unit level. A healthcare system will only succeed when everyone is working together.

While hand hygiene is not the only measure to counter healthcare-associated infections (HAIs), according to the World Health Organization, improving hand hygiene compliance can dramatically enhance patient safety, because there is much scientific evidence showing that microbes causing HAIs are most frequently spread between patients on the hands of healthcare workers. Clean hands are the number one way to reduce the rate of infections.

Hand hygiene compliance belongs at the point-of-care and across the continuum of care. Individuals,  groups and organizations can take the lead in ushering in a new era of higher hand hygiene compliance. That, in turn, requires a fresh commitment to electronic monitoring, workflow integration, data sharing, point-of-care and team-based hand hygiene improvement.          


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Topics: hand hygiene, WHO, electronic monitoring, WHO's Five Moments for Hand Hygiene, HAI, monitoring and feedback, hawthorne effect

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The DebMed blog is the go-to source for hand hygiene and infection prevention related discussions occurring in the healthcare industry. Join the conversation! All readers are invited to comment, share stories and information, and post articles of interest.

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