If Hand Hygiene Performance Isn’t the Most Important Metric…What Is?

By Clean Hands - Safe Hands

You might think it odd that an electronic hand hygiene reminder system would say that hand hygiene performance isn’t the most important metric to measure and try to improve. If it isn’t, then what is?

Missed opportunities.

Let’s look at an example comparing Nurse Robert with Nurse Anna. Robert has a hand hygiene performance rate of 30%, while Anna’s is 80%. At first glance, it appears that Robert needs to go back to Hand Hygiene School, while Anna should be celebrated. But it’s not that simple. You also have to look at the number of hand hygiene opportunities each person has.

Nurse Robert’s job mostly entails administrative duties, and he doesn’t do a lot of patient care. So over a typical week, he may only have 100 hand hygiene opportunities. At his 30% performance rate, that means he properly cleaned his hands 30 times and missed 70 times. Certainly, that’s a concern that should be addressed…but in the grand scheme of things, Robert is at a fairly low risk of spreading an infection.

Nurse Anna is one of the top nurses – always willing to help out a colleague and dutifully checking on her patients frequently. She has 1000 hand hygiene opportunities in a typical week. At her 80% performance rate, she properly cleaned her hands 800 times and missed 200 times. Over the course of a year, this is nearly 7,000 more missed opportunity than Robert has.

In terms of priority, it’s more important to focus on Anna than Robert (although, of course, both situations should be addressed). Based on the number of opportunities they both have, we can deduce that there are two very different reasons they struggle with hand hygiene.

Robert’s issue is probably education. With his low number of opportunities, it’s not likely that he’s too busy to sanitize – he probably isn’t rushing around like crazy. He may not realize that he needs to sanitize before donning and after removing gloves. He may not take care of C. diff patients frequently enough to remember that he’s supposed to wash his hands with soap and water when he exits the room. Education will likely help Robert bring up his hand hygiene performance and reduce his missed opportunities.

On the other hand, if you try to send Anna to Hand Hygiene School, it’ll likely waste her time and not change her performance. With an 80% performance rate, she probably understands how to perform hand hygiene. But she’s so busy rushing in and out of patient rooms that she can’t keep up. There are likely workflow issues that could help Anna tremendously. Perhaps she forgets to bring all the supplies she needs into a room, so she has to keep going back and forth to the supply closet. Solving workflow issues should help Anna – and other clinicians as well – to bring up her hand hygiene performance and reduce her missed opportunities.

Improving hand hygiene is critical – it reduces human suffering, saves lives, and reduces healthcare costs. In addition to hand hygiene performance rates, however, clinical supervisors also need to examine missed opportunities to find the most efficient path to improvement.

Our Performance Bubble Plots™ (shown above) can show missed opportunities by individual. If you’d like to explore how our system typically doubles hand hygiene performance rates…and has reduced HAIs by between 45% and 81% in 100% of customers following our process for 6 months…here’s a brief video about how it works. Or here’s a white paper about The 4 Data Points You Need To Reduce HAIs.


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