Becker's Clinical Quality & Infection Control

10 Hand Hygiene Target Specific Noncompliance Issues to Improve Hand Hygiene Adherence By Heather Punke A targeted approach to hand hygiene improvement — focusing im- provement efforts on specific issues of noncompliance — can be more effective than a "one-size-fits-all" strategy, according to an article in the January issue of The Joint Commission Journal on Quality and Patient Safety. The Joint Commission Center for Transforming Healthcare started its first patient safety project on hand hygiene in 2008, putting together teams in eight hospitals. Using lean, Six Sigma and change management methods, the teams measured noncompliance rates and found specific causes of hand hygiene failures. At the baseline across the eight hospitals, hand hygiene compliance rates aver- aged 47.5 percent. Reasons for noncompliance varied hospital to hospital but could be separated into 24 groups of causes, including inconvenient place- ment of hand rub dispenser or sink, broken dispensers, lack of accountability or a worker's hands being full. So, each hospital team developed specific interventions to improve hand hy- giene compliance based on the hospital's specific noncompliance issues. After the projects and improvements were implemented, there was a 70.5 percent increase in hand hygiene compliance across the eight hospitals (improving compliance from 47.5 percent to 81 percent). When hospitals customize hand hygiene improvement efforts to the issues at the individual hospital, it may be "more effective, efficient and sustainable than 'one-size-fits-all' strategies," the study's authors concluded. n Hand Hygiene Adherence Extremely Low in the OR By Heather Punke O verall adherence to hand hygiene standards in the operat- ing room sat at just 8.1 percent, according to a study pub- lished in Antimicrobial Resistance & Infection Control. Researchers in Sweden observed hand hygiene compliance during 94 surgeries using the World Health Organization's observational tool. Observations occurred in 16 ORs serving in different surgical spe- cialties like orthopedics, gynecology, urology and general. They observed a total of 2,393 hand hygiene opportunities, and the overall adherence to hand hygiene was 8.1 percent. Lowest adherence was during the induction phase before an aseptic task (2.2 percent) and the highest adherence was during full-length surgeries after body fluid exposure (15.9 percent). "There is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for ef- fective improvement strategies," the study authors concluded. They provided the following two suggestions to improve hand hygiene compliance in the OR: 1. Education and personal training in how to carry out hand hy- giene and use gloves properly 2. Optimize work processes to make hand hygiene adherence easier in the OR n H ealthcare workers touch their faces mul- tiple times each hour, and raising aware- ness of this habit and its effects could improve hand hygiene compliance, according to a study in the American Journal of Infection Control. Healthcare workers could spread germs and get sick themselves if they don't practice hand hygiene after patient contact or after contact with a contaminated environment and then touch their face — and this study shows workers touch their face quite often. Via video, researchers looked at the face-touching behavior of medical students at the University of New South Wales in Sydney, Australia. On av- erage, the students touched their face 23 times each hour. Of all of the face touches, 44 percent involved contact with a mucous membrane (36 percent involved the mouth, 31 percent involved the nose and 27 percent involved the eyes). This habit, coupled with poor hand hygiene, can lead to a healthcare worker getting sick. This information can be used to raise hand hy- giene compliance, according to the study authors. "Hand hygiene programs aiming to improve compliance with before and after patient con- tact should include a message that mouth and nose touching is a common practice," they wrote. "Hand hygiene is therefore an essential and inex- pensive preventive method to break the coloniza- tion and transmission cycle associated with self- inoculation." n Face Touching is a Habit: Raise Awareness to Raise Hand Hygiene Compliance By Heather Punke

• Cover