How Can You Increase Hand Hygiene Performance?

By Chris Hermann

A few weeks ago, we published The Top 5 Real (and Surprising) Reasons Clinicians Don’t Clean Their Hands. With The Joint Commission’s new, stringent hand hygiene standards, this is more critical than it’s ever been. Today, we’d like to outline ways to address each of these 5 reasons.

1. Remind providers to sanitize in the moment. Clinicians are hard-working, well-educated and highly compassionate people. They’re extremely busy and, most of the time, all they need is a reminder in the moment. Many electronic hand hygiene performance systems can provide these reminders. Some use lights or beeps, which we’ve heard from clinicians can often be ignored due to “alarm fatigue” in busy, noisy hospitals. Of course, we’re partial to our Real-Time Voice Reminder™, which captures providers’ attention with a human voice.
2. People don’t know what they don’t know. Even the most senior physicians may have some gaps in their knowledge about your hospital’s hand hygiene protocol. It’s typically impossible to know what any individual understands and doesn’t understand. One advantage of our system’s voice reminder is that clinicians will sometimes hear the voice when they don’t think they should. We encourage them to tell their manager or Infection Preventionist when this occurs. This brings any misunderstandings to light; it allows the manager or IP to identify knowledge gaps and educate the provider right then and there.
3. Leverage unit cultures for good. Installing hand hygiene technology and walking away doesn’t work, but pairing technology with a process for sustained behavior change does. Our proprietary process includes group competitions, which bring units together as teams to try to beat other units. This gives each unit a reason to talk about hand hygiene daily, and that, in and of itself, helps increase performance. People love to support their tribes and get competitive for the win. Even small prizes work wonders, and a public celebration of the winners helps inspire everyone.
4. Solve workflow issues. Hospitals typically aren’t aware they have workflow issues – how could they be? They need data to see where the problems lie. Our system can identify if there are particular patient rooms, times of day, or people that are struggling with hand hygiene. Once the bottlenecks have been pinpointed, the solution is typically easy. For example, we informed one of our hospitals that their hand hygiene rates consistently plummeted on Monday mornings, which they didn’t know. With a little research, they found that after a weekend of no tests or labwork being performed, nurses were under the gun to rush patients to these procedures before noon on Monday. It was so busy that they often forgot to clean their hands. The hospital changed the policy to give providers the entire day on Mondays to get tests and labwork done, and hand hygiene rates bounced back. Nurses were much happier as well.
5. Have one-on-one meetings with lower performers. It’s impossible to have individual conversations with every clinician…and it’s not necessary. Using electronic hand hygiene performance systems allows hospitals to identify the 5% or so of providers that are responsible for most of the missed opportunities. Some of these folks need education, and some may be able to learn efficiency and workflow tips from higher performers. A few may need to be encouraged to take their careers in a different direction. At least you’ll know who they are and be able to focus your time and attention on a minority of folks rather than everyone.

Most hospitals find hand hygiene to be a challenge. Changing the behavior of hundreds of clinicians can be a daunting task. But it can be done – and it can be done in a positive, supportive way.

If you’d like to explore how our system typically doubles hand hygiene performance rates, here’s a brief video about how it works, and here’s a white paper on our process of continual, positive behavior change.