Healthcare leaders share their experience with hand hygiene compliance monitoring: Insights from DebMed Symposium event at APIC 2016
Wondering what the hotspot is on a Saturday night in Charlotte? On June 11th it was the DebMed symposium as DebMed’s hometown of Charlotte, N.C., played host to this year’s APIC, and more than 200 attendees chose to spend the evening with our panel of hand hygiene thought leaders. Representing both large health systems and community hospitals, panelists Jackie Blanchard, Martha Bouk, Jonathan Schouest and Connie Steed discussed how they transformed their hand hygiene culture with e-monitoring technology and shared a few laughs with the audience of infection preventionists (IPs) from across the country.
For those of you who missed the live event, here’s the synopsis of all the key facts, story highlights and yes, some comic relief you missed. (Pictured from left, Martha Bouk, Jonathon Schouest, Connie Steed, Paul Alper, Jackie Blanchard)
The Hard Truth
The panelists started with the obvious: most IPs realize that direct observation (DO) does not present real data and therefore they take 90-100% compliance reports with a grain of salt. Besides the notorious Hawthorne Effect and staff’s reluctance to call-out their non-compliant colleagues, it is perfectly obvious the DO numbers do not tell the true story when there is no correlation between perfect hand hygiene compliance rates and healthcare-associated infections (HAIs) in a hospital.
“Hand hygiene data from direct observation is not statistically valid, and this is why we moved to implement a technology solution,” said Jonathan Schouest, MPH, St. Joseph Health Sonoma County.
Getting Buy-in, Anyway, Anyhow
Jackie Blanchard’s story of how the Atlantic Health System proved the need for real compliance data earned her a round of applause from the audience. A few years ago, she deployed a “secret witness protection program” where a group of anonymous volunteers from various departments observed staff performing hand hygiene without anyone’s knowledge. The results of the three month long confidential program showed that the true compliance rates were half of the DO reported rates of 75-85%. When eventually Atlantic Health implemented the DebMed technology, it delivered nearly the same results as the numbers reported by anonymous observers.
All four panelists agreed that to drive any meaningful change in reducing HAIs, readmissions and associated costs, they must know their true hand hygiene compliance numbers. Real data establishes a baseline and is a starting point for organizational transformation. However, how IPs use the data to drive change is just as important as the data itself in the continually evolving, complex healthcare environment.
The good news is the panel experts were glad to share their experiences with real data to help others get started. Among the most common challenges IPs will face when implementing e-monitoring technology is the resistance from staff who believed their performance was top-notch. To deal with data denial, IPs need to explain how the system works and remind or train staff on WHO Five Moments for Hand Hygiene guidelines.
Can’t Argue with Data
“If direct observers only monitor ‘in-and-out’ and report nearly 100% compliance, and then you factor in that this method captures only about 50% opportunities, you are automatically at 50% true compliance,” said Martha Bouk, RN, BSN, Riverside Medical Center, Kankakee, IL.
“Research shows that about 35% of key hand hygiene opportunities happen inside the patient room,” said Connie Steed, MSN, RN, CIC, Greenville Health System. “Direct observation cannot capture them and, if the staff are not educated and monitored for these opportunities, patients are put at risk.”
This situation is all too common and creates a hand hygiene performance gap in hospitals where staff are trained on WHO Five Moments but monitored only for two.
5 Tips for Success
A chord was struck once again on advice for implementing an electronic monitoring program. While perseverance is key, it shouldn’t be rocket science. According to Jonathan, it is helpful to get staff buy-in before a technology is selected and implemented. The staff will feel that their opinion matters and are more likely to be invested and motivated to comply in the future. Some other staff-engagement strategies that panelists have used successfully include the following:
- Assemble a multidisciplinary team when implementing the system – from nurses and physicians to environmental and food services.
- Focus on the unit level when training staff on the system and reporting compliance. Empower staff by allowing units to set their own goals, in addition to a hospital-wide goal, and let them work toward achieving them.
- When improvement is needed, ask for a specific action plan on how the unit plans to achieve the goal. Establish accountability by including hand hygiene rates on nursing report cards together with other quality measures.
- Communicate data in real time. Get compliance data for a day before and report it in daily huddles to motivate staff.
- Identify unit “influencers.” Anecdotal evidence shows that motivated and engaging managers respected by their peers and staff have higher compliance rates on their units. Have one-on-one meetings with them, get their buy-in and learn about their challenges, ideas and concerns.
The bottom line is that hand hygiene monitoring, education and improvement is an ongoing process, requiring time, effort and commitment from everyone in a healthcare organization. At the very least, IPs need to be armed with the right tools to make that process as accurate and efficient as possible in their quest for enhanced patient safety and care.
A recording of the full panel discussion is coming shortly. Subscribe