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Hospitals Not Adopting All Hand Hygiene Best Practices

January 14, 2014

Hand Hygiene Best Practice in HealthcareMore than 400 healthcare professionals from across the United States participated in a recent survey that looked at the methods used to gather hand hygiene data, the reliability of that data and the commitment of healthcare facilities to improving hand hygiene. The survey reinforced the sentiment that healthcare professionals are committed to reducing healthcare-associated infections (HAIs), but also uncovered that they are not employing the methods that they believe reflect best practices.


Of the survey respondents, the majority of whom work in patient safety and quality or infection prevention roles, the significant majority – 90 percent – indicated that reducing patient infections through increased hand hygiene compliance is one of their facility’s main focus areas. This is reassuring news as healthcare-associated infections (HAIs) remain an issue, with 1 in 20 patients contracting an infection, resulting in 1.7 million infections in the US annually, and causing 100,000 deaths.


The survey results show that 90 percent reported that they believe the World Health Organization (WHO) Five Moments for Hand Hygiene is a higher clinical standard that helps reduce the spread of infections better than cleaning just before and after patient care, a common standard in hospitals that studies show can miss up to 50 percent of hand hygiene opportunities, potentially putting patients at risk. However, the study also reports that only 30 percent of respondents have implemented the WHO Five Moments guidelines at their facility.


The WHO guidelines suggest that healthcare facilities, in an effort to reduce potential re-contamination and lower the number of HAIs, monitor five moments versus the traditional two commonly performed only upon entry and exit of patient rooms. The WHO Five Moments are before touching the patient, before aseptic procedures, after potential exposure to bodily fluids, after touching the patient and after touching the patients’ surroundings.


“The survey confirmed a significant finding, which is that healthcare organizations across the U.S. are committed to lowering healthcare-associated infections,” said Heather McLarney, vice president of marketing at DebMed. “What is needed now is for hospitals to take advantage of the latest technologies such as electronic hand hygiene monitoring systems that allow them to make a dramatic impact on the quality and safety of patient care.”


When it comes to data collection, the survey confirmed that adoption of electronic hand hygiene monitoring remains significantly behind in an industry already lagging when it comes to implementing technology solutions, with only 1.5 percent exclusively using electronic monitoring to gather data. The majority of hospitals are using direct observation, a manual and unreliable method, to monitor staff hand hygiene compliance. More than 75 percent of survey respondents, however, say they believe electronic hand hygiene compliance monitoring is a more accurate option than direct observation. Furthermore, an overwhelming number, 94 percent, believe that the Hawthorne effect, the phenomenon that subjects improve or modify their behavior when they know they are being observed, impacts the accuracy of hand hygiene compliance rates reported through direct observation, resulting in hospitals’ relying on unreliable data about the true rate of staff hand hygiene compliance. Studies have shown that the Hawthorne effect can artificially inflate hand hygiene compliance rates by as much as three times the actual rate.





The comparison of hand hygiene compliance data that hospitals report using direct observation and the belief in true hand hygiene compliance rates revealed a contradiction. The majority of respondents, 61 percent, stated that their reported hand hygiene compliance rate using direct observation is 81 percent or greater. However, only 24 percent think their true hand hygiene compliance rate is greater than 81 percent. The danger of hospitals relying on such inaccurate data is that hospitals reporting high scores may not see hand hygiene as an issue at their facility and therefore may not put enough focus on improvement efforts.


While only 1.5 percent of respondents currently use an electronic hand hygiene monitoring system currently, 15 percent of those surveyed stated they plan to purchase an electronic monitoring system within the next year.

“It is encouraging to see hospitals starting to realize the advantages of moving from the antiquated method of tracking hand hygiene compliance through direct observation to a more accurate, reliable and cost-effective electronic solution that will aid in improving hand hygiene compliance, reduce infections and save patient lives,” McLarney said.


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