Driving improvements in hand hygiene

Healthcare facilities across the globe have been encouraged to participate in the World Health Organization’s Save Lives: Clean your hands initiative, through increased compliance with its ‘five moments for hand hygiene’ approach, in a bid to reduce healthcare-associated infections (HCAIs) and the associated morbidity and mortality. The ‘five moments for hand hygiene’ was designed to add value to hand hygiene improvement strategies. It defines the key moments for hand hygiene, overcoming misleading language and complicated descriptions. It presents a unified vision and promotes a strong sense of ownership. It aligns the evidence base concerning the spread of HCAIs and is interwoven with the natural workflow of care making it easy to learn, logical and applicable in a wide range of settings. The WHO conservatively estimates that there are over 1.4 million cases of HCAI across the globe at any one time and says that healthcare workers are often the conduit for the spread of such infections to other patients in their care. In the US alone, for example, around 250 people die every day as a result of this. In the UK, The National Patient Safety Agency (NPSA) acknowledged that hand hygiene is an important component in the battle against HCAIs. It stated that, although minimising risks of infection to patients depends on a range of factors, just by increasing compliance with hand hygiene at the point of care it is possible to dramatically reduce the risk of a patient acquiring an HCAI. This, it said, is supported by scientific evidence. Direct observation is the most commonly used method for tracking rates of hand hygiene compliance in the healthcare environment. This involves someone watching and recording the hand hygiene behaviour of workers. It is a time-consuming task and the observation itself is likely to change normal behaviour. As the Hawthorn effect tells us, people will behave differently when they know they are being watched. This has the effect of artificially inflating normal hand hygiene rates. A report in the Journal of Paediatric Nursing in the US, for example, reported that direct observation in four facilities in New York were grossly overstated and over measured. This report found that compliance rates were actually 43%, rather than the 92% being claimed by one hospital. “This is evidence that direct observation and compliance rates often do not tally,” said Phil Spark, UK marketing director at Deb. There are other hand hygiene compliance tracking options available. “The cleaning product can be physically measured and this data can be correlated by shot size back to the number of hand hygiene events that have actually taken place. However, this still requires measurement and correlation back to the number of individual events,” said Phil Spark. “Video monitoring is another option, but it can be very costly to set up video cameras at every dispenser. Typically, this solution can also only be used for entry and exits and is not practical for use at a patient’s bedside as it can be considered to be too invasive. Another option is to conduct staff and patient surveys. However, this can also provide very inaccurate data,” he continued.

Changing culture

A better solution is to engage with people to try and change culture, encouraging people to do what they believe is the right thing. At the recent Reducing HCAI 2013 Improving Clinical Practice event, which was held at the Brewery Conference Centre in London, Phil Spark discussed the creation of the DebMed Hand Hygiene Compliance Programme which includes tools and guidelines to help organisation leaders to communicate to staff the importance of proper hand hygiene in creating a safer environment. Importantly, the programme now also provides a tool that enables leaders to measure compliance rates, share the information and act to improve performance in real-time. “Based on the low hand hygiene compliance rates – estimated to be around 40% to 50% – and the currently inaccurate tracking methods available, we believed that there was clearly a need for a better way to monitor and improve compliance rates,” said Phil Spark. “We wanted to produce a hand hygiene compliance monitoring system that covered all areas of the WHO 5 moments of hand hygiene,” he said. Most systems available today will only measure points one and four which are the in and out actions. Deb wanted to create something that could measure all five moments. “We were aware that the cost of monitoring and measuring compliance can be prohibitive in today’s climate so cost of the system was a high priority throughout the design process,” said Phil Spark. However, HCAIs due to poor hand hygiene can also cost hospitals a great deal of money. “One study, published in the US, for example, has demonstrated that a 1% improvement in hand hygiene compliance could save a hospital unit $40,000 every year. It is also estimated that, in the US, the cost of a non-successful hand hygiene opportunity could be up to $52,” said Phil Spark.