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Hand Hygiene Monitoring Q&A

October 24, 2012
Hand Hygiene Monitoring

What are the current problems with hand hygiene compliance? Why do healthcare facilities still fail in this area?

Proper hand hygiene is the number one way to prevent healthcare-associated infections, yet the typical rate of hand hygiene compliance is estimated to be only 40 to 50 percent.

The most commonly used method to track rates of hand hygiene compliance is called direct observation, which involves someone watching and recording the hand hygiene behavior of health care workers.

It is not only costly and time-consuming to conduct direct surveillance, but the observation itself is likely to change behavior, as people behave differently when they know they are being watched. This is known as the Hawthorne effect, which artificially inflates hand hygiene rates as the clinicians clean their hands more frequently than they normally would because they know they are being observed. In fact, a study done in Germany and published in the American Journal of Infection Control in December 2009 showed a difference of almost three times (2.75x).

Based on the low compliance rates and inaccurate tracking methods, there is clearly a need for a better way to monitor and improve hand hygiene compliance. New advances in technology have resulted in electronic monitoring systems, which offers a more accurate, cost-effective and reliable way to measure healthcare workers' hand hygiene compliance than direct observation.

Some employees may not take hand hygiene seriously -- how can they be convinced it's important?

Hand hygiene is simple, but improving compliance requires leadership, collaboration, accessibility of hand hygiene products, feedback on compliance and infection rates and individual accountability.

Hand hygiene compliance programs that have been successful include a multi-faceted approach that includes providing real-time reports on compliance performance, reminder tools such as posters and making a priority of increasing the availability and convenience of hand sanitizer and soap. A key factor in success is the hospital administration making hand hygiene compliance a hospital-wide priority through dedicated funding, encouraging the participation of senior staff, administration participating in meetings and voicing support for the program.

Accountability, feedback on compliance rates and collaboration can be addressed through an electronic monitoring system. For example, the DebMed GMS encourages higher compliance by monitoring groups instead of individuals. Group monitoring is recognized by industry experts as being more effective than other monitoring systems that track individuals' actions and can be seen by staff as punitive or as an invasion of privacy. Providing reports at the group level encourages collaboration and teamwork to improve compliance. In addition, the DebMed GMS system includes an online toolkit with educational materials designed to help change behavior, ultimately creating a safer environment for the patient.

What adverse effects can hand hygiene non-compliance have?

Loss of life and loss of revenue are the serious consequences resulting from HAIs, which account for nearly two million infections, 99,000 deaths and up to an estimated $45 billion in costs annually in the U.S alone. In 2006, an analysis of 1.69 million admissions from 77 hospitals found that patients with HAIs reduced overall net inpatient margins by $286 million.

The good news is that up to 70 percent of infections may be preventable. Preventing an infection is much less costly and easier than treating one, and saves patient’s lives.

What steps can be taken to ensure compliance and involvement from team members?

Studies have shown that providing feedback to healthcare workers on their compliance rates in a timely manner, as well as organizational characteristics such as leadership involvement, reminders, and convenient availability of products have a big influence on hand hygiene performance. Health care organizations need to integrate hand hygiene into routine procedures and have in place strong systems to support, monitor, and promote the correct behavior.


The above are excerpts from  "Promoting Hand Hygiene Through Electronic Monitoring: Q&A With DebMed", Written by Rachel Fields.


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