Everyone is talking more about hand hygiene than any point in history. Heads of state and healthcare leaders around the world on a daily basis continue to stress the importance of hand hygiene to fight the COIVD-19 pandemic. As our social world is now beginning to open back up, hand sanitizer is scattered all over every corner, and there are even highway billboards talking about the importance of hand hygiene.
You’d expect this awareness to have originated from the front line in hospitals. Most hospital executives believed this and initially we did as well. Everyone expected to see hand hygiene improve across all hospitals. There was a common feeling that with the raised awareness of hand hygiene due to COVID-19, people would be more diligent with their practices.
Turns out we were all wrong. Surprisingly, data from Clean Hands – Safe Hands’ health systems indicates that without the CHSH Natural Language Voice Reminder™, providers are not cleaning their hands any more than they normally do. In fact, most are cleaning their hands less often.
Hospitals in the first phase of the Clean Hands – Safe Hands Hand Hygiene Acceleration Pathway™ do not have the Natural Language Voice Reminder™ turned on which gently reminds providers to sanitize in the moment in case they forget. During the first phase of the Clean Hands – Safe Hands pathway, data is collected to show hospitals their baseline of hand hygiene performance, and the voice reminder is turned off.
The hand hygiene performance from Clean Hands – Safe Hands’ health systems was calculated for a six week period before and six week period after hospital operations were impacted by COVID-19 patients. Over 8.45 million hand hygiene opportunities were recorded in this period from hospitals al across the country. This included a mixture of community and academic hospitals of all sizes from small critical access hospitals to large 1,000+ bed facilities.
The hand hygiene data from all health systems with the voice reminder turned off experienced a decrease or no change in hand hygiene performance during the COVID-19 impact. All of these hospitals are in the first phase of the Clean Hands – Safe Hands pathway where the sensors are installed but the voice reminder has not been turned on. During this phase the hospitals do not have access to the data. The Voices Off Combined line (green) represents all data from the 5 health systems aggregated, not averaged.
When this data was shared with hospital leadership, they were shocked.
So what factors contributed to a decline in hand hygiene? Feedback from clinical leadership indicates that the decline in hand hygiene performance might be attributed to the increased use of personal protective equipment (PPE), specifically gloves. There have been anecdotal but consistent observations that front line staff are wearing gloves more frequently (many times inappropriately) in an effort to protect themselves. Despite what hand hygiene policies indicate, front line clinicians often incorrectly assume that gloves are a replacement for hand hygiene.
We see very commonly that when more precautions are put in place (like PPE), hand hygiene often drops due to the complexity that this adds to clinical workflows. Also as staff get more fatigued, hand hygiene consistently falls which may account for the continual decline that was seen.
This data demonstrates that without any feedback, hand hygiene has decreased as a result of the COVID-19 pandemic within hospitals. To be absolutely clear this is not the fault of the clinicians nor is it a result of an intentional change on the part of any of the clinicians. On the contrary, we have all witnessed the super-heroic acts that all healthcare providers have demonstrated to battle the pandemic.
Fortunately, not all hospitals have to suffer with poor hand hygiene performance during COVID-19. Hospitals with real time interventions like the Natural Language Voice Reminder™ are actually seeing an increase in hand hygiene performance during COVID-19, in fact, we have the data to prove it! But more on that later. In the meantime, if you would like to learn more about equipping your facility with real time reminders, contact Clean Hands – Safe Hands.