Leapfrog Updates Hand Hygiene Monitoring Requirement for 2022

By Clean Hands - Safe Hands

The Leapfrog Group is offering hospitals and ambulatory surgery centers an alternative path to meeting the organization’s Hand Hygiene Standard.

On March 14, 2022, Leapfrog released its Summary of Changes to the 2022 Leapfrog Hospital Survey & Responses to Public Comments. And though Leah Binder, the CEO of Leapfrog, indicated in January that the organization would not back down from the standard requiring hospitals to collect 200 hand hygiene observations per patient unit per month, the Summary of Changes includes an alternative path that will allow hospitals to achieve the standard in 2022 with just 100 observations per unit per month.

Hospitals and Infection Preventionists Asked Leapfrog to Revise the Standard

According to a January 28 Becker’s Hospital Review article, Binder said that “some hospitals” had asked the organization to “loosen” their hand hygiene standard. In response, she said that a diverse panel had reviewed the standard and concluded that “it is the absolute standard.”

Hospitals that do not have enough staff members to perform the required number of hand hygiene observations, she suggested, could use observance technology. 

Linda Dickey, RN, president of the Association for Professionals in Infection Control and Epidemiology (APIC), pointed out that “it takes a lot of resources to achieve” the number of required observations, further noting that “there are ways to achieve adequate appropriate hand hygiene without necessarily having to divert resources.” 

Hospitals that are facing staffing shortages and staff fatigue – and, perhaps, decreased financial resources due to loss of revenue linked to COVID19-related shutdowns and cancelation of elective surgeries – may not have the resources to invest in hand hygiene technology right now.

Hand Hygiene Didn’t Improve During the Pandemic – and HAIs Increased

Despite widespread and increased attention to infection control during the COVID-19 pandemic, hand hygiene performance did not improve in most hospitals and healthcare facilities. According to one study that examined hand hygiene compliance in three medical units at a regional hospital in Denmark before and during the pandemic, two units had better hand hygiene compliance before the pandemic; in the third department, compliance was unchanged. 

A study from the University of Chicago Medical Center showed dramatic increases in hand hygiene compliance early in the pandemic – with compliance rates peaking in late March 2020 – but compliance declined by mid-August 2020. The authors of the study conclude that “high compliance is possible, even with automated monitoring, yet difficult to sustain.”

Perhaps unsurprisingly, the number of healthcare-associated infections (HAIs) increased during the pandemic. According to an article published in the November 2020 issue of the American Journal of Infection Control, a hospital in New York experienced a 420% increase in CLABSIs and 179% increase in CAUTIs. A similar-sized hospital in St. Louis experienced a 324% increase in CLABSIs and a 57% increase in CAUTIs.

Hospitals Can Achieve the Leapfrog Hand Hygiene Standard with 100 Observations in 2022

According to Leapfrog’s Summary of Changes, hospitals and ambulatory surgery centers will be able to “achieve the standard” in 2022 by either collecting hand hygiene compliance data on at least 200 hand hygiene opportunities or at least 100 hand hygiene opportunities each month in each patient care unit, as long as the facility can also answer “yes” to all of the questions in the Feedback, Training and Education, Infrastructure, and Culture domains of the hand hygiene standard. 

Hospitals and ambulatory surgery centers will also have two options for measuring the volume of alcohol-based hand sanitizer dispensed with each activation: 1) a volume-based measurement or 2) the “15-seconds to dry” method.

Given that the Leapfrog Group has previously expressed strong support for a minimum requirement of 200 hand hygiene observations per unit per month – and underscored the fact that hand hygiene is vitally important given the recent increase in HAIs – it is doubtful that the 100 observations per unit per month alternative will remain an option for a long.

Though hospitals may be able to achieve Leapfrog’s hand hygiene standard in 2022 with just 100 observations per unit per month, healthcare facilities should continue to aim for at least 200 – and plan to invest resources in technology that will enable them to consistently meet that standard in the future.


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