Bringing Hand Hygiene Compliance Monitoring Into the 21st Century

By Heather McLarney

The Association for Professionals in Infection Control and Epidemiology (APIC) and Infection Prevention and Control (IPAC) Canada annual conferences are just around the corner. Industry leaders will come together to exchange knowledge and creative solutions toward our shared goal of reducing hospital-acquired infections (HAI) and associated costs – financial and beyond. Many types of technology and solutions will be presented to enhance every aspect of the infection preventionist role, including hand hygiene compliance monitoring.

In an age when advanced technology rules every aspect of our lives, how we monitor hand hygiene compliance should not be left behind. Unlike last century’s outdated direct observation method, modern, science-based technologies give numerous advantages to hand hygiene champions. For example, facilities can now take advantage of electronic hand hygiene compliance monitoring systems which utilize research-based and published benchmarks for the expected number of times staff should clean their hands based on the hospital type and size and the unit type,  hourly patient census, nurse-to-patient ratio and the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) hand hygiene guidelines, considered to be a higher clinical standard than simply cleaning hands before and after contact with a patient.

In addition to benefiting from the latest technological advancements, infection prevention efforts are also transforming due to shifts in healthcare regulations that are assuring that hospitals take the right steps and increase patient safety, or pay the price. In the U.S., 721 hospitals faced penalties in fiscal year 2015 from Medicare’s Hospital-Acquired Conditions Reduction Program, just one of the four pay-for-performance programs that are in place and include infection-related quality measures.

A comprehensive hand hygiene program, including advanced monitoring, can contribute significantly to reducing HAIs and increasing patient safety. In assessing a compliance monitoring system, there are several factors to keep in mind.

Comprehensive monitoring: Hand hygiene compliance belongs at the point-of-care and across the continuum of care. Does the system have the ability to monitor hand hygiene activity of the sanitizer pump bottles in the patient zone, in addition to wall-mounted soap and sanitizer dispensers? Can the system be used in all healthcare environments, including outpatient, ambulatory and long-term care settings?

Ease of installation and use: Ideally, a monitoring system should not disrupt clinical workflow, allows for easy data sharing, and promotes team-based hand hygiene improvement. It is also important to understand the impact on your hospital’s IT team to support the installation; whether or not the system will need to be integrated or will interfere with other systems; and the level of effort required to install the infrastructure. Is it a standalone system that eliminates these issues or one that requires dedicated time and resources to support?

Methodology: Make sure to understand exactly which hand hygiene opportunities are being tracked. Data obtained based on adherence to the WHO and CDC guidelines, rather than simply before and after patient care, sets a higher standard for the staff and patients. How does the system calculate compliance? Is it based on research and published scientific insight, or simply tracking when staff enter and exit patient rooms?  How does the system account for all the opportunities for hand hygiene inside the room during the course of care? Can the system be customized to reflect the actual care delivered in that specific unit given factors critical to real-world compliance, such as the number of patients at any given time and the nurse-to-patient staffing ratio? Knowing the methodology, properly training the team on expectations for when they should clean their hands, and providing feedback on compliance rates to staff on an ongoing basis will assure optimal results.

Impact on culture: Does the system single out and report compliance on individual staff members, which can be perceived as punitive, or does it track compliance at the unit level to encourage staff to work as a team to improve? Which system type would be most suitable for the organization? How will staff feel about using wearable devices, and what is involved in having to charge up, maintain and assign those devices to staff? It is important to check with your HR and legal departments regarding any potential privacy or liability issues with tracking individuals.

Real-time and accurate data: Healthcare facilities need data in real-time to know when and where to focus interventions to drive behavior change to realize the patient safety and financial benefits. The data also needs to be accurate in order to achieve buy-in from the frontline staff. Has the compliance calculation method used by the electronic monitoring system been proven accurate in published research?

Costs: Compliance monitoring systems vary in their installation requirements, compatibility with existing equipment and operational costs based on the type of technology used, infrastructure required, and amount of supporting hardware and wearable devices. Is the system one you can afford to implement system-wide, or is it cost-prohibitive to install it in more than just a few units?

In addition, consider the payment and fee structure. Is the system considered capital equipment or can it be paid for as a service subscription? Are installation, maintenance, training and support charged as additional expenses, or are they included? While new technologies will require an investment, be smart about what you do and do not need to pay for.

Educational and training support:  At the end of the day, improving hand hygiene compliance is really about behavior change. Does the vendor include educational and training support to help reinforce hand hygiene compliance to help you meet your goals? Is it part of the program, or are there additional costs? Make sure that your team receives the proper support so that you are confident in your use of the system and adoption is high from day one.

Hand hygiene compliance group monitoring system proves its worth: a case study
One example of a successful implementation of an electronic hand hygiene compliance monitoring system is Riverside Medical Center in Kankakee, Ill., a 325-bed Magnet-recognized® hospital serving a four-county area. As is often the case, simply stressing the importance of hand hygiene to clinical staff was not sufficient to maintain a consistently high level of compliance, so the hospital opted for the DebMed Group Monitoring System (GMS), a science-based system that provided the following:  

• Unit-level compliance monitoring
• Research-based methodology
• Tracking based on the WHO and CDC guidelines
• Accurate and real-time data
• Onsite training and online toolkit of support materials

After the DebMed GMS system was implemented, the hospital’s overall hand hygiene compliance nearly doubled, rising from 32% to 62%. For more details about the Riverside Medical Center’s experience, please view this YouTube video.

Moving Forward

For the past several years, DebMed has been surveying more than 400 infection preventionists, nurses and other healthcare leaders each year from North American hospitals to explore methods used by hospitals to gather hand hygiene data, its reliability and the commitment of healthcare facilities to improving hand hygiene. The answers reveal that while there are gaps in the measurement and reporting of hand hygiene compliance throughout hospitals, there is a growing awareness of the need for accurate electronic monitoring data and commitment to better practices. Improved hand hygiene compliance monitoring can dramatically increase patient safety and care and is a critical part of the strategy to avoid outbreaks of infections. 

As our industry gears up for the APIC and IPAC conferences, we can set forth a challenge for everyone:  Let us learn about the latest technologies and best practices in hand hygiene to increase patient safety, enhance quality of care and reduce costs, moving infection prevention into the 21st century.

Heather McLarney is vice president of marketing at DebMed.