There is little argument today that proper hand hygiene by clinical staff reduces the spread of Hospital Acquired Infections (HAIs). The challenge is how to make it happen consistently.
Old methods of direct observation haven’t worked. Direct observation was, at one point, considered the gold standard, but numerous studies have shown that this method is fatally flawed. No matter how much effort is put into keeping these observers anonymous, the staff figures it out, and as a result, the numbers are artificially inflated.
New technologies are making headway, especially when paired with a process that is less about compliance and more about fun. A recent implementation at a large hospital in Georgia demonstrates how quickly one can see results.
Early electronic monitoring offered hope…but it wasn’t the ultimate solution
When electronic monitoring technology originally came along, hospitals were able to track hand hygiene in more detail. The technology highlighted the ineffectiveness of direct observation by clinical staff or volunteers. Hospitals that thought (through direct observation) they had compliance rates of over 90%, had a rude awakening when electronic monitoring systems measured true compliance rates of under 30% in many cases.
It’s clear to many hospital infection control professionals that the ability to monitor compliance electronically is a step in the right direction, but doesn’t offer a clear path to improvement that is sustainable over the long haul. The technology by itself is like a thermometer. It can tell you when patients are sick, but it doesn’t offer any way to help them get better.
A consortium of physicians and technologists
A team of physicians and technologists in Georgia began working in 2007 to develop a new approach to the problem of hand hygiene. The research consortium consisted of investigators from the CDC, Emory University, Children’s Healthcare of Atlanta, Georgia Tech and the Georgia Tech Research Institute.
The team started with the premise that clinicians are skilled professionals that are busy and simply forget to wash their hands. This foundational premise led them to look beyond just monitoring and build a comprehensive solution to change behavior. The foundation of the system is a gentle voice reminder that plays only when a provider forgets to clean hands. The team found that the voice reminder is the single biggest driver to impel change.
Sensors on alcohol and soap dispensers gather data from badge reels without disrupting the provider’s workflow, which enables insights both at the individual and group level. A flexible network enables hospitals to adapt the system to workflows and protocols all the way down to the level of individual patients. For example, the rules, timings, and reminder can be customized for patients with C. diff.
One recent project in a large Georgia teaching hospital offers a good example of how data, when paired with a systematic process that encourages improved hygiene performance, can be effective in stopping HAIs at their source.
74 percent drop in C. diff
The team recently partnered with The Medical Center, Navicent Health (MCNH), a 637-bed academic Level 1 trauma center in Macon, Georgia. The hospital had minimal success with a “mystery shopper” who observed staff during an intense hand hygiene promotion campaign, but found increased compliance rates were difficult to sustain.
“We know hand hygiene is the number one way to reduce infections,” says Nancy Osborn, infection prevention manager. “We were doing due diligence with direct observation, but weren’t seeing the results we needed.”
“The voice reminder is so subtle,” says Osborn. “Staff members are comfortable with the data and how to access it. They can see the shift in group performance and in their own scores. And it’s fun. We have pizza parties for winning teams and a gentle, non-punitive, educational approach.”
Most importantly, the hospital saw hand hygiene compliance rates double in the units where the system and process were implemented. Like many hospitals, Navicent was focused on C. diff reduction and leveraged the technology’s unique ability to adapt to the specific needs of patients with C. diff. As a result, the hospital saw C. diff infection rates drop by 74 percent over the first 6 months.
Susan Harris, Senior Vice President and Chief Operating Officer for MCNH, notes, “The voice reminder has driven positive behavior change at the clinician level, which has led to a significant decrease in C. diff. This is a huge victory for us. Not only because our patients are safer, but because we have saved nearly $200,000 in just 6 months.”
The hospital has also undergone an evolution in the way it thinks about hand hygiene compliance, and that, Osborn says, is the key to success. More than a campaign that might focus everyone’s attention on hand hygiene for a month, the hospital has a foundation for ongoing improvement that has been embraced by providers at all levels, from physicians to nurses to technicians.
Chris Hermann, PhD is the Founder and CEO of Clean Hands Safe Hands (CHSH). He has a PhD in Bioengineering, a MS in Mechanical Engineering, a BS in Biomedical Engineering with High Honors from the Georgia Institute of Technology, and is a MD candidate at Emory School of Medicine.