Becker's Clinical Quality & Infection Control

23 Hand Hygiene A lack of standardization in how hand hy- giene-related solutions are arranged at hospital emergency department washba- sins may have an effect on performance, accord- ing to a study published in the American Journal of Infection Control. To examine the extent to which incorrect hand hygiene occurred as a result of the inability to easily distinguish between different hand hy- giene solutions placed at washbasins, research- ers conducted a direct observational study using six ceiling-mounted, motion-activated video cameras at the washbasins of a hospital in Australia. All total, 459 episodes of hand hygiene were re- corded by the six cameras in a 24-hour period. They found: 1. There were 171 (37.3 percent) hand hygiene episodes recorded at type L washbasins (soap so- lution on the left side and moisturizer on the right side) and 288 (62.7 percent) at type R washbasins (soap solution on the right side and moisturizer on the left side). 2. Nearly all (412 out of 420 observations, or 98.1 percent) of the intended hand hygiene episodes were performed correctly using a soap-based so- lution. 3. The correct hand hygiene product was used for 412 of the 439 of the observed hand hygiene epi- sodes, or 93.8 percent. 4. Twenty-seven of the hand hygiene episodes (6.2 percent) were performed incorrectly, including: • One episode in which moisturizer was used instead of soap • One episode in which alcohol was used instead of soap • Nine episodes in which only water was used (without soap solution); and • 16 episodes that involved the use of two products, simultaneously. 5. Most (87.5 percent) reached for the moisturizer first and then dispensed soap solution. 6. Hesitation was observed for 26 hand hy- giene episodes (5.8 percent). For 11 episodes, the moisturizer was applied first and then soap solution, whereas in 15 episodes the potential error was recognized prior to application, and the hands were ultimately washed with soap solution. The study authors argue the inconsistent place- ment of hand hygiene products contributes to poor hand hygiene behaviors and that, conversely, standardizing their relative positioning and color and appearance would improve hand hygiene compliance. "The standardization of the relative location of handwash solutions, such as soap on one side and hand drying agents on the other, or preferably still locating moisturizer away from soap, may improve hand hygiene behaviors," concluded the study authors. n Does Product Placement in the ED Influence Hand Hygiene Performance? 6 Study Findings By Shannon Barnet 1 in 4 Hospitals Need to Improve Hand Hygiene Practices, Says Leapfrog: 5 Report Findings By Shannon Barnet O verall, hospitals have been improving hand hygiene practices, but in 2014, one in four still had not implemented all the safe practices and policies recommended for proper hand hygiene, according to a report by The Leapfrog Group. The report is based on data taken from the 2014 Leapfrog Hospital Survey of 1,501 U.S. hospitals and analyzed by Castlight Health. It examines how many hospitals meet all 10 of Leapfrog's hand hygiene practices. To name a few, Leapfrog's practices include having hospitalwide hand hy- giene education and training, submitting hand hygiene recommendations and results to the hospital board, holding clinical leadership accountable for compliance and implementing performance improvement programs. Highlighted below are five findings from the report. 1. The percentage of hospitals meeting all 10 of Leapfrog's hand hygiene practices increased from 69 percent in 2013 to 77 percent in 2014. 2. For the fifth consecutive year, urban hospitals outperformed rural hos- pitals; about 20 percent more urban hospitals than rural hospitals met Leapfrog's standard and showed greater year-over-year improvement in meeting the standard. 3. The level of adoption of hand hygiene safe practices varies significantly state to state: In five states, more than 90 percent of reporting hospitals met all practices, while in six states, 60 percent or less of reporting hospi- tals met all practices. 4. Nearly all (99 percent) of reporting hospitals achieved hospitalwide education and training to prevent hospital-acquired infections related to inadequate hand hygiene. 5. Hospitals struggled to hold patient safety officers directly accountable for improving hand hygiene through performance reviews or compensa- tion. Only 87 percent of reporting hospitals indicated having this practice in place. n SAVE THE THE SAVE THE THE

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