Technology-Assisted Observation Can Improve Hand Hygiene

By Madison Pittman

Healthcare providers know that hand hygiene is key to reducing healthcare-associated infections (HAIs). And yet, despite that knowledge and countless hours of staff education – not to mention investments in cute posters and handwashing systems – hand hygiene performance rates at most hospitals remain stubbornly low.

According to the U.S. Centers for Disease Control and Prevention (CDC), healthcare providers clean their hands less than half of the times they should, on average. However, most providers legitimately believe that they are appropriately cleansing their hands at the proper times. When asked to self-assess their hand hygiene performance, 80% of providers estimate that they fulfill all hand hygiene expectations 80-100% of the time.

In reality, 70% of healthcare providers have a hand hygiene rate below 50%. What better time than National Hand Washing Awareness Week (Dec. 1 – 7) to take a closer look at this discrepancy and shed some light on the disconnect.

The Gap Between Perception and Reality

Why do conscientious, caring personnel clean their hands only about half as often as they should? The answer may lie in “predetermined perceptions of what is ‘clean,’” according to a 2013 article in the American Journal of Infection Control.

CDC guidelines for hand hygiene in healthcare settings state that staff members must wash or disinfect their hands:

  • Before patient contact
  • Before inserting catheters, IVs and other invasive devices, even if gloves will be worn during the insertion
  • After contact with a patient’s skin
  • After contact with body fluids, nonintact skin or wound dressings
  • After glove removal

These guidelines mean that staff members may need to cleanse their hands multiple times within a single patient encounter, but a number of those instances are not obvious.

Staff should cleanse their hands after each instant of patient contact, including a simple handshake. But because many people don’t perceive handshakes as ‘dirty,’ it’s easy for a nurse to forget to clean her hands in between shaking the patient’s hand and emptying his urinary catheter.  

Most healthcare providers aren’t even aware of instances of missed hand hygiene. That’s why traditional hand hygiene improvement efforts like posters and mandatory staff education haven’t led to an appreciable increase in hand hygiene.

Raise Awareness with Technology-Assisted Observation

Before staff can change their behavior, they must be aware of their current actions.

According to the American Journal of Infection Control, “unless information about hand hygiene rates that is obtained by monitoring is provided to staff, it is highly unlikely that anything will change.” But obtaining accurate hand hygiene data has long been a challenge.

Direct observation – essentially, one human observing another – is time-consuming, expensive and prone to bias. Numerous studies have shown that people wash and sanitize their hands more often when they realize they are (or may be) watched, which means that direct observation can’t give you an accurate, on-the-ground look at hand hygiene practices.

Technology-assisted observation is less obtrusive and can produce thousands of data points. The Clean Hands — Safe Hands system uses sensors embedded in badge reels and on soap and alcohol dispensers to collect real-time data on hand hygiene incidents.

This information can be shared with staff members to provide an accurate look at baseline hand hygiene — a crucial step in changing behavior. Management and staff can also study the data to reveal patterns of behavior, allowing for the creation of hand hygiene interventions that are tailored to meet the needs of clinicians functioning in specific settings.

The Power of Actionable Data

As discouraging as it may be to see baseline hand hygiene rates under 50%, accurate data is essential to positive change. In fact, because this data truly reflects the on-the-ground reality, “there is evidence that electronic monitoring of hand hygiene is not only more accurate than direct observation, but that it is also associated with practice improvement,” according to the American Journal of Infection Control.

In other words, simply collecting and sharing accurate, real-time data may motivate staff to improve hand hygiene efforts. However, greater improvements are noted when staff discuss the data in context and use the tools at hand to support best practices.

As noted in the American Journal of Infection Control, “the 4 important characteristics associated with high adherence [to clinical practice guidelines is] that the feedback given [is] timely, nonpunitive, individualized and customizable so that it [is] meaningful to staff.”

Technology Can Close the Gap & Improve Hand Hygiene

The Clean Hands — Safe Hands system is designed to facilitate staff engagement. Auditory Real-Time Reminders verbally cue providers to perform hand hygiene at critical moments, and gamification (in the form of group and individual competitions) provides additional motivation while maintaining a positive, nonpunitive environment.

These interventions can lead to a dramatic improvement in hand hygiene. A 2018 study published in The Journal of Hospitakidl Infection found that systems that provide auditory notifications can increase hand hygiene performance rates from 53.8% to 80-100%.

Clean Hands — Safe Hands customers typically report a doubling of hand hygiene rates – and a 45-81% reduction in healthcare-associated infections. Get in touch to learn more about how you can utilize the Clean Hands — Safe Hands system to improve hand hygiene in your facility.

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