Fall 2010: How Are We Doing With Hand Hygiene Compliance?

As the 2010-2011 influenza season gets underway, healthcare professionals remain vigilant for changes in the rates of patients reporting influenza-like illnesses. Weve laid the groundwork with proactive hand hygiene education and prepared our crisis response with additional product availability. But what if local or national patient influenza-like illness (ILI) reports do not sound any alarms and levels remain within reasonable expectations?

Maryanne McGuckin, ScEd., MT (ASCP), encourages hospitals not to allow complacency to set in with healthcare workers hand hygiene habits when the worst-case scenario for illness transmission is not realized at their particular healthcare center. McGuckin is founder of McGuckin Methods International and oversees a national hand hygiene compliance database with monthly data contributed by hundreds of hospitals across the U.S. as well as sites abroad.

"We remind hospitals and ambulatory facilities to be consistent with your programs for education, monitoring, and feedback, and to be sure methods include multiple approaches to monitoring compliance," McGuckin says. "Whether we are facing the onset of a virus strain like we experienced with 2009 H1N1 on a worldwide scale, or if we are facing other foes like MRSA or C. difficile locally on one or two units, infection preventionists (IPs) are consistently challenged with keeping their teams washing and sanitizing their hands when anticipated outbreaks turn out to be merely blips on the radar. Complacency leads to relaxed habits which are obviously not acceptable."

In 2010, McGuckin and colleagues reviewed monthly compliance rates leading up to and including the 2008-2009 flu season (before wide-spread awareness of H1N1 emerged), and then compared those rates with data one year later, in the period leading up to and including the 2009-10 flu season (when we prepared for H1H1 to be a strong presence during our winter flu season). The results were presented at the Fifth Decennial International Conference on Healthcare-Associated Infections held in March.

In the summer months leading up to 2009-10, compliance in ICUs, non-ICUs and EDs was higher than in the same time previous year, as we were still learning about H1N1 transmission factors and anticipating an unknown winter 2009-2010 experience. However, the higher compliance rates fell mid-winter. When comparing the 2009-10 compliance data to data from the CDC on patients reporting influenza-like illnesses during the same time period, time-trend data suggested that when patients reporting ILIs decreased, compliance soon went down as well.(1)

The McGuckin team inquired with the IPs to share their insight on why they thought compliance decreased when we were supposed to be on alert for H1N1, to see what other factors besides patient illness reports may be impacting the numbers. However, one IP summarized what many others expressed which supported the McGuckin teams initial explanation, that since the rate of patients reporting influenza-like illnesses were not as high as the hospital anticipated, her healthcare workers felt like dodged a bullet and were less compelled to wash their hands as frequently as when the patient rates were anticipated to be much higher.

How does this impact our work today, in the fall of 2010? The CDC reports lower incidents of patients reporting influenza-like illnesses in the first two weeks of October 2010 compared to the same time in 2009.(2) Preliminary results from the McGuckin database for September 2010 show hand hygiene compliance is closer to 2008 levels at this time than it was at this time in 2009 (when we anticipated H1N1).

"This may suggest that, without an illness or anticipated outbreak getting our attention, we dont strive to reach compliance goals," says McGuckin. The team will be monitoring the national trends in compliance as the 2010-11 flu season progresses.

McGuckin Methods International manages a national database for hand hygiene compliance using product usage measurement as a low-cost means of identifying areas that might require additional resources in time and cost for observation. The program is accessible to all interested acute or ambulatory healthcare centers. Goals are established for unit types such as ICUs, non-ICUs and EDs, and all hospitals in the program strive to reach common goals using common methodology for measurement. Visit www.hhreports.com for more information.

References:

1. Govednik J, Waterman R, McGuckin M. What Effect Did Novel A H1N1 Have on HH events at the Bedside in US Hospitals? A Multicenter Analysis of Compliance in ERs, ICUs, and Non-ICUs. Abstract presented at the Fifth Decennial International Conference on Healthcare-Associated Infections. March 2010.

2. U.S. Centers for Disease Control and Prevention. Seasonal Influenza (Flu) Weekly Report: Influenza Summary Update website. Accessed 10/27/2010. Available at: http://www.cdc.gov/flu/weekly/index.htm