The updated expert hand hygiene guidance that appeared in the July 2014 issue of the Journal of Infection Control couldn’t have arrived at better time. Those of us who manage and advise healthcare facilities on infection prevention and control live and work in challenging times. Just consider the news.
The rate that hospitals—especially community hospitals—recognize carbapene resistantEnterobacteriaceae (CRE) rose more than five times between 2008 and 2012, according to the August 2014 issue of Infection Control and Hospital Epidemiology. Meanwhile, the director of the Centers for Disease Control and Prevention (CDC) is warning of a “post antibiotic” world. To that end, he’s argued for improved detection, isolation and prevention of drug-resistant infections, including incentives for drug makers that develop drug-resistant antibiotics.
Increase access to and acceptance of soap and alcohol based rubs. Healthcare organizations , including hospitals, health systems, physician practices, labs, imaging centers, long-term care facilities, and pharmacies, must join the quest for full hand hygiene compliance by making hand hygiene products easy to access, understand and use throughout the work day and on every shift.
But locating products within each work area or unit may not be enough. Caregivers need hand sanitizer dispensers at the point of care to supplement their use of hand sanitizers available through standard wall–mounted units. Only then can caregivers fully comply with the World Health Organization (WHO) Five Moments of Hand Hygiene.
Develop and promote a disciplined approach to hand hygiene compliance. Simply reminding caregivers to clean their hands will never suffice. Nor will settling for hand hygiene compliance before and after patient care–a practice that can miss up to 50 percent of hand hygiene opportunities, according to The World Health Organization. Instead, hospitals and other clinical settings must inform, educate and train professionals and patients on WHO’s Five Moments for Hand Hygiene or the CDC’s guidelines for hand hygiene in healthcare settings. Only by insisting on the highest clinical standards will they ensure hand hygiene compliance and protect the safety and wellbeing of patients, families and providers.
Monitor progress toward full hand hygiene compliance. Once caregivers are trained on hand hygiene compliance, healthcare organizations must prepare to monitor and evaluate performance. Relying on the honor method or enlisting colleagues or observers to track compliance almost always fails. Statistics tend to be inaccurate, incomplete, inconsistent and unclear. In other cases, compliance numbers are inflated due to the Hawthorne Effect.
Far better is conducting a process of needs assessment and planning, including evaluation of risks and benefits, before moving on to hand hygiene system selection and implementation. Many hospitals have already discovered that electronic forms of hand hygiene compliance monitoring offer data and information that aid in evaluating individual and team hand hygiene performance.
Build a culture around patient safety and hand hygiene compliance. The name of the game is caregiver empowerment. That, in turn, calls for multidisciplinary task forces and committees with the knowledge, skill and talent to design, implement, promote and evaluate hand hygiene compliance programs.
Caregivers are better apt to comply with hand hygiene protocols if they are given clear targets and access to accurate, real time data and information on individual and team performance. If hand hygiene compliance isn’t up to par, hospital staff rely on directors of infection control and others to outline improvement plans that tap the intelligence and collaborative power of teams.
Hand hygiene is an opportunity to engage and involve caregivers, patients and families. While establishing structure and performance goals against targets is key, so is the need to recognize, reward and celebrate hand hygiene compliance champions. Contests, competitions and ceremonies go a long way toward making hand hygiene compliance a valuable, satisfying and vital component.
Hand hygiene is a journey, not a destination. Providers, payers, government, patients and vendors must come together to stem the tide of dangerous and costly infections.
Related Resources (2014 materials and studies)
Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals