The Leapfrog Group and the Positive Effect on Hospital Hand Hygiene

Hand hygiene and HAIs with Leapfrog Group

(Adobe Stock)

The Leapfrog Group

The Leapfrog Group, a Washington, DC-based national nonprofit organization established in 2000 by leading employers and health care experts, advocates for transparency in hospitals by releasing various levels of performance data to the public.¹ Leapfrog’s initiative aims to improve the quality and safety of American health care. To highlight this quality and safety information in an easy-to-understand format, the Leapfrog Group biannually assigns safety grades ranging from A to F to general short-term acute-care hospitals across the US. These grades are based on evidence-based patient safety measures, including hand hygiene policies, infections, falls, and trauma.¹

For hand hygiene in particular, the Leapfrog Group is the sole agency publicly reporting on Hand Hygiene activities in hospitals, with a gold standard of 200 recorded hand hygiene opportunities per month in each patient care unit.² The impact of Leapfrog’s hand hygiene reporting is proving promising results. The achievement of Leapfrog’s standard for hand hygiene has improved dramatically since scoring first began in 2020. In that first year, “only 11% of hospitals achieved the Hand Hygiene Standard, compared with 38.1% in 2021, 57.6% in 2022 and 74% in 2023 – an almost 7-fold increase in achieving the standard in just 4 years.”⁴

Hand Hygiene Contribution to Hospital Performance

The Leapfrog Group’s hand hygiene standard includes 5 domains: monitoring, feedback, training and education, infrastructure, and culture, and the standard encourages facilities to adopt a multimodal approach to hand hygiene, emphasizing the importance of monitoring and feedback promising.² Scoring based on meeting specific criteria within the hand hygiene component is part of the overall Leapfrog Hospital Safety Grade within the process/structural domain.

While hand hygiene is just one of over 20 measures in the 2024 hospital grade, it accounts for 4.7% of the grade weight,² and we estimate that a hospital’s performance in hand hygiene can affect much more of a hospital’s overall grade. This is because hand hygiene reduces health care-associated infections (HAIs).

The World Health Organization (WHO) estimates that 50% of avoidable infections are preventable by using appropriate hand hygiene.⁴ Given this information, considering the sum of half of the weight for each of the 5 listed common HAIs listed under the outcome measure domain of the table below (Central line-associated bloodstream infection, catheter-associated urinary tract infection, surgical site infections, such as colon, methicillin-resistant Staphylococcus aureus, and Clostridioides difficile) with the addition of the weight of the hand hygiene measure, hand hygiene alone can influence up to 15.4% of the overall Safety Grade Score. This also means hand hygiene has enough pull to impact a hospital’s letter grade by 1 value, depending on performance.

Photo of the Leapfrog Group’s Hospital Safety Standard Weight Measures Table in the Scoring Methodology PDF

(Credit with permission from author)

Electronic Hand Hygiene Initiative-One Hospital’s Response

One hospital that serves as a prime example of the positive impact of publicly available hand hygiene performance data is a 180+ bed midwestern hospital. In the fall of 2019 and spring of 2020, the hospital received an A grade with HAIs performance slightly below average. However, in the fall of 2020, their grade dropped to a B. When observing their performance measures, this deficiency appeared due to a minor increase in HAI instances, namely C difficile. This facility also did not reach the full Leapfrog Hand Hygiene standard for 2020.

The facility implemented an electronic hand hygiene monitoring system (EHHMS) in 2021 to address this issue. Since implementation, the hospital has successfully reduced its HAI rates, restored its grade to an A, and maintained it consistently. Furthermore, they have achieved a perfect 100-hand hygiene score since implementing the EHHMS in their facility.

*Photo of the Fall 2020 Leapfrog Group’s Hospital Safety Grade Infection Dashboard for the Anonymous Facility in this Study *The Leapfrog Group. (2024).²

Table based on the Centers for Medicare & Medicaid Services (CMS) Health care Associated Infections (HAIs) Counts by Year for the Anonymous Facility in this Study

(Table credit to author with information from CMS)

Summary

The Leapfrog Group plays a pivotal role in enhancing the quality and safety of health care in the US through its commitment to transparency and performance reporting. The organization has significantly improved patient safety outcomes by assigning safety grades to hospitals and focusing on critical measures such as hand hygiene. Hand hygiene not only contributes to the overall safety grade but also has a substantial impact on reducing HAIs, which are a significant concern in hospital settings. The case of the midwestern hospital exemplifies how targeted interventions, such as implementing an EHHMS, can lead to improved performance and higher safety grades. As The Leapfrog Group continues to advocate for best health care practices, its efforts are crucial in fostering a culture of safety and accountability within hospitals, ultimately benefiting patients nationwide.

References

1. Fanto S. What is Leapfrog in Health Care? The Implications of Hospital Safety Grades. Cox Prosight. Published November 15, 2022. Accessed November 15, 2024. https://www.coxprosight.com/post/leapfrog-hospital-safety-grades
2. The Leapfrog Group. Scoring Methodology Spring 2024 Safety Grade. Leapfrog Hospital Safety Grade. Published 2024. Accessed November 15, 2024. https://www.hospitalsafetygrade.org/media/file/Safety-Grade-Methodology-Spring-2024.pdf
3. The Leapfrog Group. U.S. Hospitals Are Making Dramatic Progress in Hand Hygiene. Leapfrog Data Analysis. Published 2024. Accessed November 15, 2024. https://www.leapfroggroup.org/sites/default/files/Files/leapfrog-HH-report-2024_FINAL.pdf
4. Key facts and figures: World Hand Hygiene Day 2021. World Health Organization. Published 2021. Accessed November 15, 2024. https://www.who.int/campaigns/world-hand-hygiene-day/2021/key-facts-and-figures