The 90’s Club: A Successful Hand Hygiene Adherence Campaign

The 90’s SwipeSense Club

Hand hygiene plays a crucial role in preventing infections, as emphasized by the World Health Organization (WHO), which has identified 5 key moments for hand hygiene. These moments are defined as follows: 1. before touching a patient, 2. before a procedure, 3. after a procedure or exposure to body fluids, 4. after touching a patient, and 5. after touching the patient's surroundings.¹ These moments provide clear opportunities for health care team members to practice hand hygiene.

According to WHO data, the global average hand hygiene adherence rate is around 40% when no targeted interventions are implemented to improve adherence. However, adherence rates are higher in critical care settings, averaging around 60%.¹ This discrepancy underscores the importance of implementing effective strategies to enhance hand hygiene practices, particularly in critical care areas where infection prevention is paramount.

90's Club Member Loyalty Card

(Photo credit: authors)

Incorporating evidence-based interventions and initiatives, such as educational campaigns, monitoring systems like SwipeSense, or behavioral nudges like the "90’s Club," can significantly elevate hand hygiene adherence rates across health care settings, ultimately reducing the risk of health care-associated infections (HAIs) and improving patient safety outcomes.²

SwipeSense represents a robust improvement intervention utilized by health care systems to monitor and enhance hand hygiene adherence, ultimately aiding in reducing HAIs.² This system incorporates caregiver badges, hygiene sensors, location hubs, and communication hubs strategically installed throughout facilities to track hand hygiene practices effectively. Within designated care areas, hygiene sensors, location hubs, and communication hubs work collaboratively to detect the completion of hand hygiene tasks, providing real-time data on adherence rates. Team members are equipped with caregiver badges, which interact with the system upon entering these care areas.²

The literature underscores the critical relationship between hand hygiene adherence and the prevalence of specific HAIs. For instance, research has shown that low hand hygiene adherence rates correlate with increased Clostridioides difficile infections.^1,3 In contrast, improved hand hygiene practices have been associated with reduced rates of central line-associated bloodstream infections (CLABSIs)¹ and surgical site infections (SSIs).³ By leveraging systems like SwipeSense to monitor and bolster hand hygiene adherence, health care facilities can proactively mitigate the risk of HAIs, contributing to enhanced patient safety and quality of care.

90's Club Handout

(Photo credit: authors)

A 146-bed community hospital is committed to delivering remarkable patient care, including reducing infection risks. Recognizing the critical role of hand hygiene in infection prevention, the facility implemented SwipeSense in late March 2021. SwipeSense, a solution designed to enhance infection control and behavior change in health care settings, utilizes smart sensors, digital applications, and change management expertise to create a safer environment for caregivers and patients.² This transition from manual hand hygiene observations to SwipeSense provided more accurate data on hand hygiene opportunities and adherence rates among team members.

The data gathered from SwipeSense revealed a positive trajectory in hand hygiene adherence over subsequent years. By the end of 2021, adherence had reached 53%, marking the initial impact of integrating SwipeSense into our protocols. By the close of 2022, adherence improved to 58%, demonstrating a continued adherence trend to hand hygiene practices.

A significant milestone was achieved with the launch of the 90’s Club initiative in April 2023. This initiative was developed to incentivize and recognize individuals or teams consistently demonstrating high levels of hand hygiene adherence. Following the introduction of the 90’s Club, hand hygiene adherence surged to an impressive 78% by the end of 2023 and has a current score of 84% for 2024 through May, highlighting the effectiveness of targeted promotions in sustaining improved hand hygiene behaviors across the facility. (Table 1.)

The combination of SwipeSense technology and strategic initiatives like the 90’s Club has played a pivotal role in continuously enhancing hand hygiene practices at Novant Health Thomasville Medical Center in Thomasville, North Carolina. These efforts contribute to a healthier and safer environment for all stakeholders, aligning with the hospital's commitment to providing remarkable patient care.

Table 1: Novant Health Thomasville Medical Center in Thomasville, North Carolina's 90's Club results.

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(Image credit: authors)

The creation of the 90’s Club was driven by concerns regarding hand hygiene adherence and the importance of raising awareness among team members. This initiative aimed to motivate and incentivize staff to achieve a 90% adherence rate by introducing a fun and engaging reward system. Team members who reached 90% adherence in a month were eligible for induction into the club and received a punch on a loyalty card. Accumulated punches allowed members to redeem 1990’s-themed nostalgia prizes, including popular candies like Blow Pops, Ring Pops, Pop Rocks, and Pixy Stix, as well as items such as yo-yos, Puzzle balls, Rubik's Cubes, bracelets, and the chance to win a gift certificate.

To promote the 90’s Club, vibrant flyers were distributed throughout the facility, inviting team members to join. Leaders within the hospital actively discussed the club during staff meetings, safety huddles, and one-on-one interactions, emphasizing the importance of hand hygiene and the benefits of participation. Adherence percentages were tracked monthly, and those achieving 90% or higher received recognition through punches on their loyalty card.

Members who maintained a 90% or higher adherence rate for 90 consecutive days received special acknowledgment from executive leadership, including a personalized letter and a lapel pin symbolizing their dedication to hand hygiene and patient safety. Establishing the 90’s Club successfully fostered a culture of awareness and commitment to hand hygiene among team members, ultimately contributing to improved adherence rates and a safer health care environment.

Data Is Collected by SwipeSense

SwipeSense adherence data is collected and accessed at this community-based hospital through an online data dashboard, which provides detailed information on individual team members' hand hygiene adherence scores. This dashboard serves as a valuable tool for identifying areas of improvement and optimizing workflow related to hand hygiene practices. Through regular review of the data, the facility recognized certain patterns, such as team members who held dual roles experiencing a reduction in positive adherence momentum.

Specifically, certified nursing assistants (CNAs) often transitioned into patient safety attendant (PSA) roles, assigned to provide one-on-one patient observation. This shift in responsibilities could impact hand hygiene adherence rates among these team members. By leveraging SwipeSense data, the facility gained insights into these dynamics. It explored strategies to support and enhance hand hygiene practices, particularly when staff members assume multiple roles within patient care settings.

Using SwipeSense's data dashboard underscores the commitment to continuous improvement in infection control and patient safety. This ensures that hand hygiene remains a priority across various operational contexts within the health care facility. This proactive approach facilitates targeted interventions and initiatives to foster a culture of excellence in hand hygiene practices among all team members.

The accuracy of hand hygiene adherence data obtained through SwipeSense can be influenced by several factors related to the functionality of communication hubs, location hubs, and hygiene sensors. For instance, team members must wear the hand hygiene tile correctly at chest level to ensure optimal sensor detection and accurate data collection. Wearing the tile in a pocket may result in missed detections, leading to potential underreporting of adherence even when team members adhere to hand hygiene protocols.

Specific roles within the health care setting, such as CNAs transitioning into PSA positions, present unique challenges for data accuracy. When CNAs are assigned to sit with a patient for extended periods (in or just outside the patient's room), their continuous presence near a specific patient’s room may register multiple misses on hand hygiene adherence associated with that room. To address this issue and enhance data accuracy, CNAs were instructed to remove their hand hygiene tiles while performing PSA duties.

Identifying and addressing these operational challenges allows for effective navigation through workflow processes and obtaining more precise percentage adherence scores. By optimizing SwipeSense technology and implementing tailored protocols, the facility strives to achieve reliable and meaningful insights into hand hygiene practices across various care settings. This proactive approach supports ongoing efforts to enhance infection control measures and ensure patient safety throughout the health care environment.

The successful implementation of the 90’s Club has resulted in a notable increase in overall hand hygiene adherence among team members. This improvement reflects a heightened awareness of the critical link between hand hygiene practices and the prevalence of HAIs throughout the facility. Team members are working towards achieving and maintaining a 90% adherence rate through the club's initiative, leading to a cultural shift towards increased responsibility and commitment to infection control.

In addition to the positive impact on hand hygiene adherence, the facility has observed promising trends in infection rates during 2023. Specifically, there was a significant reduction in HAIs, including a 100% decrease in methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia, a 50% decrease in C difficile infections, and a 33% decrease in MRSA infections.

The link between better hand hygiene and lower infection rates emphasizes the importance of proactive infection prevention. Health care facilities can use SwipeSense data and ongoing monitoring to improve patient safety measures. This data-driven approach targets areas for improvement and guides interventions to reduce HAIs. The success of the 90’s Club showcases the facility's dedication to patient safety through accountability, continuous improvement, and adaptability in infection control strategies, leading to sustained improvements in patient outcomes and overall quality of care.

References

1. Your 5 moments for hand hygiene. World Health Organization. Accessed July 9, 2024. https://www.who.int/multi-media/details/your-5-moments-for-hand-hygiene-poster
2. SwipeSense, Inc. Accessed July 9, 2024. https://www.swipesense.com/
3. First-ever WHO research agenda on hand hygiene in health care to improve quality and safety of care. World Health Organization. Accessed July 9, 2024. https://www.who.int/news/item