Leapfrog Hand Hygiene Survey: 3 Surprising Facts

By Clean Hands - Safe Hands

You know how important your Leapfrog Hospital Safety Grade is to your institution’s reputation and functioning. And you know that the Leapfrog Hand Hygiene Survey contributes to your facility’s safety grade. You probably also know that Leapfrog has repeatedly emphasized the importance of hand hygiene, stressing their intent to hold organizations to high standards for the good of patient health. 

But it’ll take more than a general emphasis on hand hygiene to earn a top grade. If you want to earn an “A,” pay attention to these three surprising facts about the Leapfrog Hand Hygiene Survey:

1. 200 hand hygiene observations are needed per unit each month

The Leapfrog Hand Hygiene Survey asks hospitals to collect hand hygiene compliance data on at least 200 hand hygiene opportunities per unit, per month. 

Though 200 sounds like (and is!) a big number, it’s still a fraction of the thousands of hand hygiene opportunities that occur each month on every unit. (According to the U.S. Centers for Disease Control and Prevention, a healthcare provider may need to clean their hands 100 times in a single 12-hour shift.) The challenge, of course, is collecting that amount of data while simultaneously continuing to provide timely patient care.

That’s why some hospitals asked Leapfrog to ease the hand hygiene requirements. In response, Leah Binder, Leapfrog’s president and CEO, told Becker’s Hospital Review that a “diverse panel” had reviewed the standards and determined them to be the “absolute standard.” However, if a hospital is unable to collect 200 observations per unit per month, a recent Leapfrog update suggests that hospitals may be able to earn partial credit by reporting data on 100 hand hygiene opportunities per unit. 

Smaller hospitals can report observations appropriate to their units’ average daily censuses. Units with an average daily census of 10-12 patients need to report hand hygiene compliance data for at least 150 hand hygiene opportunities, for instance.

The need to collect and collate so much data is one reason why Leapfrog is encouraging the use of electronic hand hygiene systems, noting that the “sheer numbers of hand hygiene opportunities covered by the two monitoring strategies [direct observation and electronic monitoring] represent powerful evidence in favor of electronic monitoring.” The organization’s Factsheet: Hand Hygiene also stresses the fact that “Facilities that have adopted electronic compliance monitoring systems are better able to determine their actual hand hygiene compliance rate, creating the opportunity for more robust quality improvement initiatives.”

2. A “unit” is any setting that provides direct bedside nursing care

Traditionally, hospitals only monitored hand hygiene performance on units that are required to report healthcare-associated infection (HAI) rates. The Leapfrog Hand Hygiene survey explicitly requires hospitals to report hand hygiene rates for all patient care units, including observation units, pediatric units, emergency departments, and pre- and post-operative units. 

Outpatient and ambulatory care areas, in particular, “provide unique challenges to monitoring HH [hand hygiene] compliance,” according to the International Society of Infectious Diseases. And because of that difficulty, little is known about hand hygiene performance in these crucial areas. A 2019 study published in the Journal of Hospital Infection noted that, to that point, there had been “no comprehensive reviews on hand hygiene in EDs [emergency departments].” Of the studies the authors found – 12 small interventional studies – only 33% of them reported hand hygiene compliance rates of more than 50%.

That’s a problem, as EDs frequently manage a high volume of patients in close proximity to one another – a situation which increases the risk of infection transmission and requires excellent hand hygiene to decrease that risk.

3. Hospitals must validate both electronic hand hygiene monitoring systems and direct observation of hand hygiene

Leapfrog wants accurate hand hygiene data because they know that inaccurate data won’t help healthcare facilities make (or demonstrate) meaningful improvements in their efforts to improve patient safety. An excellent hand hygiene compliance rate is useless if it’s not accurate.

That’s why Leapfrog requires hospitals to validate the reliability and validity of whatever system they use to monitor hand hygiene. A hospital that chooses to use direct observation to assess hand hygiene compliance will need to conduct “regular quality monitoring of the accuracy of observations that are collected by each observer.” 

This monitoring would “include having an individual trained in infection control simultaneously collecting data with the hand hygiene compliance observers and comparing results.” So, hospitals that utilize direct observation essentially need to devote at least two staff members to hand hygiene observation on a regular basis. 

Alternatively, hospitals can choose to use an electronic hand hygiene monitoring system that’s been validated by either hospital personnel or third-party personnel. Validation of electronic systems includes checking (and correcting, if needed) the positioning of the monitoring devices to be sure they are accurately collecting hand hygiene data. 

Hospitals that are aware of and act on these three surprising facts about the Leapfrog Hand Hygiene Survey will be well-positioned to earn a top Leapfrog Safety Grade.


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