The Key to Improving Hand Hygiene Performance During COVID-19

By Madison Pittman

A few weeks ago, we shared some alarming news. Despite the fact that everyone is talking about hand hygiene more than any other point in history, healthcare providers are not washing their hands any more than usual. In fact there is a very consistent downward trend with hand hygiene across the country.

For a quick recap: hospitals in the first phase of the Clean Hands – Safe Hands Hand Hygiene Acceleration Pathway™ do not have the Natural Language Voice Reminder turned on which gently reminds providers to sanitize in the moment in case they forget. During the first phase of the Clean Hands – Safe Hands pathway, data is collected to show hospitals their baseline of hand hygiene performance, and the voice reminder is turned off.

The hand hygiene data from all health systems with the voice reminder turned off experienced a decrease or no change in hand hygiene performance during the COVID-19 impact. The Voices Off Combined line (green) represents all data from the 5 health systems aggregated, not averaged.

This information troubled and shocked healthcare leaders. The hospital leadership expected that with raised awareness due to COVID-19, providers would be sanitizing more, not less. Unfortunately, feedback from clinical leadership indicates that the decline in hand hygiene performance might be attributed to the increased use of personal protective equipment (PPE), specifically gloves. Despite what hand hygiene policies indicate, front line clinicians often incorrectly assume that gloves are a replacement for hand hygiene.

Fortunately, not all hospitals are suffering with poor hand hygiene performance during COVID-19. In fact, hospitals with the Natural Language Voice Reminder™ have actually seen an improvement in hand hygiene.

We analyzed data from our customers in later phases of the Hand Hygiene Acceleration Pathway™. Unlike customers in the first phase of the pathway, all of these hospitals have the voice reminder turned on. If a provider forgets to clean their hands when they should, the voice gently reminds them in real time. As long as they sanitize shortly after, they get credit.

All of the health systems with the voice reminder turned on experienced an increase in hand hygiene performance. Beginning at Week 0 (when COVID-19 began impacting the hospital) there was a consistent and steady improvement in hand hygiene for the health systems. This occurred independently of the phase that the hospital was in. Based on the data collected by our system, we were able to determine that leadership engagement dropped when COVID-19 impacted the hospital. This was confirmed by speaking with hospital leadership. The Voices On Combined line (light blue) represents all data from the 5 health systems aggregated, not averaged.

The difference in hand hygiene performance between hospitals with voice reminder and without the voice reminder is astounding. The figure below represents the aggregated data for all systems. The green line represents the aggregated total for hospitals with the voice reminder off. The blue line represents the aggregated total for hospitals with the voice reminder on.

During COVID, there was a 38% relative improvement in hand hygiene in health systems with the CHSH Voice Reminder turned on, in contrast to a 40% relative decrease with no reminder.

In our experience, the reason the voice works is that is raises awareness to specifically the times that the staff forget to perform hand hygiene. Providers typically clean their hands every time they remember but are not aware of the times that forget to perform hand hygiene. Despite the heightened awareness of hand hygiene, hospitals without the voice turned on are likely experiencing a decrease in performance because their providers aren’t aware of the times they forget to perform hand hygiene. When providers get busy, they’re more likely to forget about hand hygiene. Fortunately, hospitals with a voice reminder experienced an improvement in hand hygiene performance. The heightened awareness of hand hygiene due to COVID-19 combined with the reminder helps providers stay on top of their hand hygiene performance.

To learn more about how Clean Hands – Safe Hands helps hospitals improve their hand hygiene performance during COVID-19, contact us.

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