Accurate measurement of handwashing is a key starting point. The eight participating hospitals, using the Center’s measurement methods consistently, found on average that caregivers washed their hands less than 50 percent of the times in which they should have washed their hands. That’s a lot of missed opportunities. It was also somewhat of a surprise, says Benedicto. The organizations did not expect such low compliance.
“It really brings home the fact that random observation is an unreliable measure of compliance,” she continues. “The high compliance rate that many hospitals are reporting is probably not accurate. That is why we recommended that hospitals take a different approach to get a realistic assessment of actual performance in real time: use trained and certified independent observers to monitor hand hygiene; take measurements 24/7, at all times of the day, every day of the week.”
Detailed information about the root causes and identified solutions is available on the Center’s Web site (http://www.centerfortransforminghealthcare.org/projects/about_hand_hygiene_project.aspx). And in mid-2010, organizations that are accredited by the Joint Commission will be able to access a customized set of solutions.
The aforementioned Web site lists solutions to problems in the following manner:
Cause: Ineffective placement of dispensers or sinks
Solution: Provide easy access to hand hygiene equipment and dispensers
Cause: Hand hygiene compliance data are not collected or reported accurately or frequently
Solutions:
• Data provide a framework for a systematic approach for improvement
•Utilize a sound measurement system to determine the real score in real time
•Scrutinize and question the data
•Measure the specific, high-impact causes of hand hygiene failures in your facility and target solutions to those causes
The personnel of the pilot units selected by the participating hospitals knew they were being observed, Benedicto says. However, they did not always know who the observers were.
“These hospitals did use ‘secret shoppers,’ though, to measure hand hygiene compliance,” she continues. “They also used other valid measurement systems to collect compliance rates, and the statistical process control charts validated the stability of the measurement system. But it was interesting that biases were discovered in virtually all non-secret shopper observations. This led to reliance on secret shoppers until technology solutions were initiated. Beta testing is still being conducted on the technology solutions.”
While most of the participants were hospitals, that doesn’t mean the solutions tested there are only appropriate in that setting. A majority of solutions will translate to other settings, including small and rural hospitals, Benedicto asserts.
“We believe—but will confirm with future work—that the solutions developed by the participating hospitals will be effective for the same causes when they appear in other hospitals,” she says. “For example, if a small hospital finds that some of its caregivers don’t wash their hands prior to entering a patient room because their hands are full, that hospital will likely find that the same solution developed by a participating hospital (e.g., the installation of a simple shelf near a hand gel dispenser) will work for them.”