Becker's Clinical Quality & Infection Control

16 Executive Briefing W hen Jeffrey A. Jackson, MD, chief quality officer and prior chief of medical staff at Houston Methodist Sugar Land (Texas) Hospital went on a cruise with his family, he noticed that with minimal effort patrons were induced to perform hand hygiene. He observed that a badged staff member near the ship's entrance and the dining room entrances would pump hand sanitizer into patrons' hands as they waited in line. He felt it was a simple solution to help combat norovirus — a very contagious gastrointestinal virus that that can be problematic if it spreads on cruise ships. Although healthcare-associated infections were not a significant problem for HMSL, Dr. Jackson wondered how he could apply what he saw on the cruise to help increase hand hygiene compliance and further prevent HAIs. "HAIs are one of the most common sources of preventable harm, are associated with high costs, and U.S. hospitals are being penalized and denied reimbursement for those HAIs that have been deemed preventable," Dr. Jackson said. "As a result, many hospitals are working toward transformation into high reliability organizations through a leadership- driven focus on strong patient safety foundations. Proper and sustained high hand hygiene compliance is one of those behaviors that aligns with our goals." Hand hygiene is one of the most foundational aspects of patient safety that spans across all hierarchies and disciplines, and there is much room for improvement in virtually every healthcare organization. Hand hygiene is one of the most foundational aspects of patient safety that spans across all hierarchies and disciplines, and there is much room for improvement in virtually every healthcare organization. "The Centers for Medicare and Medicaid Services (CMS), national accreditation organizations such as Joint Commission and DNV GL Healthcare, and patient safety organizations, like The Leapfrog Group, expect hospitals to demonstrate improvement by monitoring hand hygiene, setting goals for improvement and demonstrating progress," said Firas Zabaneh, director of system infection prevention and control, Houston Methodist Hospital System (HM). For decades, direct observation of personnel by trained observers has been the "gold standard" for monitoring hand hygiene compliance. However, it may not provide sufficiently accurate and actionable data. Breaking the current paradigm "Consistent with our journey to high reliability — in 2016, the Houston Methodist board challenged the system quality and patient safety department to explore methods other than 'vendor secret shopper' as means to measure hand hygiene compliance. Two approaches were explored: the hand hygiene Targeted Solutions Tool (TST) offered by Joint Commission, and an approach that relies on electronic monitoring - automated hand hygiene monitoring systems (AHHMS)," said Robert A. Phillips, MD, PhD, chief physician executive and system chief quality officer at Houston Methodist Hospital System (HM). "As chairman of the HM hand hygiene committee, Dr. Jackson was charged with executing on these two approaches." To address the AHHMS option, Dr. Jackson approached his hand hygiene product vendor, GOJO Industries, to explore the PURELL SMARTLINK™ Activity Monitoring System (AMS) — a group monitoring system that electronically tracks soap and sanitizer dispenser activations (events) and room entries and exits (opportunities) to provide real- time performance metrics. AMS provides hand hygiene data on an aggregate level, including staff, patients and visitors. Three different HM hospitals piloted AMS for the better part of a year during 2016. Because the system captures data 24/7, AMS collected tens of thousands more opportunities per month than did direct observation. When a new hand hygiene baseline was established using the AMS system, follow-up surveys revealed that the staff were concerned about the much lower than expected compliance rate, and they expressed the strong desire for more granularity of the data; in particular, individual performance rates. "Based on a follow-up patient survey, the hospital learned that patients felt safer knowing that their healthcare providers' hand hygiene was being monitored. This, and the feedback from the AMS pilot results employee survey, showed our HM leadership that this was an opportunity to align organizational goals around hand hygiene," Dr. Jackson said. "We all agreed to continue on this journey to a new phase." While the AMS pilot piqued the interest and captured the imagination of the staff, they had asked for more user- specific and granular data that was specific to individual healthcare providers. True to their culture of continuous improvement and transparency, Dr. Jackson and HM leadership approached GOJO about taking a next step forward and exploring a person-specific monitoring system that provides hand hygiene data at the individual employee level. The PURELL SMARTLINK™ Integrated Monitoring System (IMS) was in the pre-commercialization phase, and Dr. Jackson, on behalf of Houston Methodist, The current state of hand hygiene In collaboration with GOJO

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