The debate of whether healthcare professionals are keeping their hands clean enough made it all the way to the House of Commons in the United Kingdom recently. The issue is that some UK hospitals are reporting hand hygiene compliance rates as high as 100% though independent studies show the real numbers can be as low as 18%. As a result, instances of hospital-acquired infections (HAIs) persist. This is resulting in “unnecessary infection”, said Nigel Mills, Member of Parliament (MP) who led the debate.
1 in every 16 patients admitted to hospitals in the UK contract an infection during their stay. That means 300,000 patients are affected every year by HAIs, resulting in 5,000 deaths and costing the UK’s National Health Service up to 1-billion (GBP) annually. HAIs are a global issue that can affect anyone, regardless of location or economic class. For example, each year in the United States, 1.7 million HAIs result in 99,000 fatalities. This makes it one of the leading causes of death behind cardiovascular disease and cancer in the US.
Healthcare workers, patients and visitors to hospitals spread about 80% of common infections. The World Health Organization (WHO) says clean hands are the number one way to reduce the rate of HAIs. According to MP Mills, 30% of infections can be avoided by increased hand hygiene compliance, based on the existing standards and practices. Some studies have even reported this preventable statistic can be as high as 70% - a staggering fact that could ultimately save thousands of lives every year.
In an effort to understand and ultimately reduce HAIs, hand hygiene compliance information is collected and reported by hospitals. The current standard for measuring hand hygiene compliance is something known as direct observation. This essentially involves trained-observers manually tracking healthcare worker's compliance during a specific period of time.
One of the big issues with direct observation is the simple fact that most people tend to behave differently when they know someone is watching. This is known as the Hawthorne Effect, and it is understood this method can inflate reported hand hygiene compliance rates by as much as 50% or more. Additionally, the validity of this method has come under increased scrutiny in recent years – especially with new technologies including 24/7 electronic hand hygiene monitoring. According to infection control experts, when it comes to measuring hand hygiene rates, there can be no grey area and the results reported must be unequivocal.
For example, trials conducted in the UK using electronic hand hygiene monitoring technology showed real compliance rates in the range of 18%-40% - even though 90%-100% had been reported. "The current methods of reporting (hand hygiene compliance) are not only inaccurate, but they are also taking up valuable nursing time which could be applied elsewhere if more accurate reporting methods were employed," added Mills.
Similar electronic trials in the United States using technology that monitors group performance have shown hand hygiene compliance can increase as much as 40% in as little as 4-months. Unlike other systems that focus on tracking individual compliance, group-monitoring systems (GMS) emphasize improvement as a unit, transforming the compliance culture as a whole. This team-based approach not only works effectively to reach hand hygiene goals but also, helps to maintain these new standards by ultimately changing behaviour.
“The incidents of HAIs highlight that current checks are woefully inadequate as hospitals are reporting higher levels of compliance. I would like to see the Government introduce measures to reduce the rate of HAIs and look closely at how data is collected to ensure data on hand hygiene is captured accurately to ensure quality improvements,” Mills commented. There is a significant opportunity for hospitals to move away from antiquated methods and embrace a new global standard for accurately measuring hand hygiene compliance in healthcare.
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