They Think They’re Cleaning Their Hands … They’re Wrong

By Clean Hands - Safe Hands

If you take an honest look at hand hygiene literature, it’s widely reported that hand hygiene in the US remains well below 50%. That said, when you speak with most hospital leaders, you’ll be hard pressed to find anyone who will acknowledge that their hand hygiene rates are this low…or even that they have any problem at all! Have you ever found a clinician who admits they wash their hands less than half the time?

We asked this question over 2,500 times and were surprised by how far healthcare providers’ perception of their own hand hygiene differs from reality. What we learned helps explain why hand hygiene continues to be a struggle for healthcare systems, and, more importantly, gives insight into how we can finally fix this problem for good.

Before we install our hand hygiene reminder system in a new hospital, we survey the clinical staff that will be using our technology. We ask them what they think their hand hygiene performance rate is.

At the same time, we install our hand hygiene system for a silent period of four to six weeks while we gather baseline data. We use this primarily to analyze staff workflow patterns, so we can adapt our system for the unique layouts and workflows that vary unit by unit. In addition, this allows us to collect millions of hand hygiene opportunities that represent the reality of hospital hand hygiene rates of thousands of individual providers.

The graph below is a histogram that shows the data collected from many different hospitals about their perceptions (blue) compared with the reality that was measured at the same time (gray). The horizontal axis represents hand hygiene performance – farther right is better. The height of the bars represents the number of clinicians in each performance range.

Hand Hygiene Perception vs Reality

The vast majority of providers – 80% – estimate that their hand hygiene performance is between 80% and 100%. However, the reality is vastly different – over 70% have a hand hygiene rate below 50%. Fewer than 1% of the providers have hand hygiene rates that are within the ranges that they believe they’re in!

Why is there such a discrepancy between perception and reality? More importantly, how can we can use this data to solve the problem of hand hygiene?

Healthcare workers genuinely believe they’re cleaning their hands every time they’re supposed to. This is because every time they think about performing hand hygiene, they do it. But when they don’t think about performing hand hygiene, obviously they don’t notice that they’ve forgotten to clean their hands. Said another way…in every instance, providers do not make an intentional decision to fail to clean their hands.

Clinicians are hardworking, highly educated and caring individuals. They understand the link between hand hygiene and healthcare-associated infections (HAIs). They honestly feel like they’re cleaning their hands all the time, but they’re only human. And they’re often overworked.

On a busy shift, a nurse may need to perform hand hygiene over 200 times. Even if she only hits the 50% mark, she will have sanitized 100 times, which makes her feel like she’s constantly cleaning her hands…and she’s right. The problem is, as she’s taking care of patients, she’s appropriately thinking about the patient and loses track of hand hygiene. This is something even I experienced recently in taking care of a critically ill patient.

Good intentions only go so far and there are only so many times that clinicians can be re-educated with the same results. What is needed to actually improve the state of hand hygiene is making providers aware of the times that they are expected to perform hand hygiene in the moment. That’s what our system does with our patented Real-Time Voice Reminder™.


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