Human behavior. It can be tricky. Did you know that on average it takes 18 – 224 days to make a new behavior an ingrained habit? Think about all the New Year’s resolutions that go broken long before the end of January. But in healthcare, the need for behavior change to stick is more than preference; it can mean life and death.
When it comes to hand hygiene compliance, one could argue driving this positive behavior change is even more complicated. After hospital staff are educated and trained, they may transfer to another unit or change jobs. Some managers may be more engaged with hand hygiene than others. A nurse may have an extra-busy day and forget to wash or sanitize before putting in an IV. Occasionally, there is a mystery of a unit where high and stable compliance rates suddenly decline for no apparent reason, a cue for an Infection Preventionist or a unit manager to find out what have caused the drop. This is why hospitals need ongoing monitoring – to keep track of and react to things as they happen.
This much was clear to me in 2009 as I watched my direct observers report top compliance rates I knew were inflated. Reasons for inaccuracies ranged from inherent limitations of direct observation to the well-documented Hawthorne Effect. That’s why I welcomed an opportunity to test a completely different methodology – electronic hand hygiene monitoring – and did so through the studies Greenville Health System conducted with the DebMed technology over the course of seven years. The studies have also guided the system’s development.