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By Chris Hermann, PhD
Hand hygiene is the foundation of infection prevention, but often doesn’t get the same attention as other factors. While one could argue that hand hygiene isn’t the most exciting infection control intervention, it can have the biggest impact on reducing healthcare-associated infections (HAIs) and is the only intervention that can impact all types of HAIs.
Although washing hands hasn’t fundamentally changed in over a century, there are a surprising number of changes happening in the hand hygiene industry. Let’s take a look at the top five hand hygiene trends we’re seeing for 2019.
1. Increased Pressure and Penalties. About a year ago, the Joint Commission ratcheted up pressure for healthcare organizations to improve hand hygiene with new guidelines. In line with their warning, surveyors have issued citations to hospitals nationwide after witnessing a single failed hand hygiene opportunity. This results in potential revisits and could even put the hospital’s accreditation at risk. As a result, hospitals are getting more serious about making immediate and significant improvements in hand hygiene performance.
2. Less Reliance on Direct Observation. Partially the result of increased pressure from the Joint Commission, healthcare organizations are less likely to use secret shoppers when monitoring hand hygiene performance with direct observation. Most of them have known for years that direction observation doesn’t work, but it was easier to continue with the status quo (as flawed as it was) than investing energy and time in making a change.
There are many reasons direct observation doesn’t work. A multitude of human biases are involved, such as the Hawthorne Effect in which providers who know they’re being watched (and they always figure it out) are three times more likely to clean their hands. In addition, the sample sizes are too small. And as we like to say, “you don’t make a chicken fatter by weighing it.” That is, any method to simply monitor hand hygiene performance â direct observation or otherwise â does not change nor improve the results.
Many hospitals continue to submit misleading data that shows hand hygiene performance rates above 95 percent, yet their HAI rates have not dropped and some of these hospitals are even on the HAC (Hospital-Acquired Conditions) list. If the nationwide average for hand hygiene is below 50 percent and you say you’re at 95 percent, but you’re also on the HAC list, in reality your hand hygiene data is not accurate. Most leading organizations are becoming more willing to face the fact that this data is seriously flawed and getting leadership support to fix it.
3. More Reliance on Actionable Data. The Internet of Things (IoT) and big data have revolutionized a number of industries and they’re beginning to transform healthcare as well. When used to monitor hand hygiene performance, IoT sensors and other technology can capture hand hygiene performance data without bias, unlike direct observation. This data can be analyzed in new and exciting ways, with cutting edge visualization that makes it easy for healthcare managers to identify the highest risk individuals, patient conditions and hospital rooms on a granular level.
Many electronic hand hygiene technologies integrate with electronic medical record systems, so there’s a seamless flow of information between the two, automatically syncing patient condition with hand hygiene protocols in the system. This combined data can be used to identify the most at-risk patients for targeted interventions.
4. Real-Time Intervention. Monitoring hand hygiene performance is one thing but changing clinician behavior to actually improve results is something else entirely.
A growing number of healthcare organizations are relying on real-time interventions to improve hand hygiene performance in the moment. This includes reminding providers to sanitize their hands by using lights, beeps, vibrations and/or a human voice that are activated when a healthcare worker fails to clean their hands. These can be remarkably effective in changing behavior and improving performance. We’re seeing increasing adoption of these technologies.
Real-time interventions can also take the form of text messages that warn unit managers of hotspots â patient rooms where hand hygiene is unusually low, particularly for patients in isolation or with C. diff. This type of intervention can alert managers to high-risk situations, so they can intervene before a problem can spread.
5. Lower Costs. Electronic hand hygiene systems that gather and analyze reams of actionable data, provide real-time interventions and reduce the chance of a Joint Commission citation, have come down in price. While there appears to be a misconception in the marketplace that this technology is expensive, it’s surprisingly affordable and becoming more so as time goes on. Most of these systems provide a tremendous ROI due to reducing infections, reducing HAC and readmission penalties, and eliminating the need for staff to spend precious time doing direct observation. With these financial advantages, hospitals are adopting electronic hand hygiene systems at a faster pace than ever before.
The Bottom Line
With dropping prices, a solid return on investment and mounting pressure to improve hand hygiene, we’ll see more hospitals in 2019 moving away from direct observation to leverage actionable data and real-time interventions that change clinical behavior.
Chris Hermann, PhD, is the founder and CEO of Clean Hands â Safe Hands. Hermann started and led the multi-institution research collaboration that developed the core technology utilized in the CHSH system. He earned a PhD in bioengineering, a MS in mechanical engineering, a BS in biomedical engineering with high honors from the Georgia Institute of Technology and is an MD candidate at Emory School of Medicine.