Becker's Clinical Quality & Infection Control

18 Executive Briefing Trading in Pens and Paper for a 21st Century Hand Hygiene Monitoring System Compliance with hand hygiene guidelines is of utmost importance when it comes to infection control and preventing deadly and costly healthcare associated infections. According to a 2009 study in the Journal of Hospital Infections, "healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment." Indeed, the World Health Organization calls hand hygiene a "simple, low-cost action to prevent the spread of many of the microbes that cause healthcare-associated infections." And the Centers for Disease Control and Prevention says, "hand hygiene is one of the most important ways to prevent the spread of infections." Despite all of this, compliance with hand hygiene protocols remains a struggle in many hospitals, and, in turn, U.S. hospital patients suffer about 722,000 infections and nearly 100,000 die annually, according to CDC data. "Healthcare-associated infections are an epidemic, but not a permanent part of healthcare. This is a fixable problem," says Mert Iseri, CEO of SwipeSense, which has developed a technology- driven hand hygiene monitoring system. "Hand hygiene happens to be at the top of the list of things we can do to battle HAIs." In addition to its positive effect on HAI rates, improving hand hygiene compliance can also have a positive effect on a hospital's bottom line. HAIs are costly occurrences — total costs added to the healthcare system from HAIs sits somewhere between $35 billion and $88 billion every year, according to "The Cost of Healthcare Associated Infections," a report from GE Healthcare IT. Additionally, CMS is no longer reimbursing hospitals for care provided for several hospital- acquired conditions, including catheter-associated urinary tract infections, central line-associated blood stream infections and ventilator-associated pneumonia. That means such infections — which hand hygiene can help prevent — cost hospitals $23,228 on average every time they occur, according to GE Healthcare IT. Because improving hand hygiene compliance has widespread positive consequences on HAI rates, hospitals are increasingly dedicating more resources to improving adherence. Unfortunately, the old-fashioned ways of measuring hand hygiene aren't very effective. When hospitals use visual observation as the main system of measuring hand hygiene compliance, they will likely get inflated or unnaturally high numbers that suggest no improvement is needed. "The old way of monitoring employees for hand hygiene is all subjective; you can't monitor every employee 24/7," says Jeff Baker, SwipeSense's chief commercialization officer. Cathy Sanders, MSN, RN, CIC, director of infection prevention and epidemiology at Brookwood Medical Center in Birmingham, Ala., experienced that phenomenon firsthand. The hospital was using the "secret shopper" method, with employees observing colleagues' hand hygiene habits unbeknownst to them. Over time, however, the method became not-so-secret, with word getting out as to when observations were occurring. "People would be better that day and consistently report 80 to 100 percent compliance," she says, but on days when infection prevention staff would secretly observe, the recorded compliance rates were closer to roughly 35 percent. That is more on-par with actual hand hygiene compliance at most hospitals. Mr. Iseri says hospitals no longer have to settle for the archaic way of monitoring hand hygiene. "We're living in a world where pen and paper [hand hygiene monitoring] is acceptable, but it doesn't have to be. The technology is there." Transitioning from pens and paper to digital monitoring According to Mr. Baker, "New technology… will allow hospitals to develop a basis for holding people accountable for washing their hands, and it monitors and measures everyone's performance equally." Using technology to monitor hand hygiene can allow hospitals to not only get a better read on their compliance rates, but they can also use the technology to drive sustainable and meaningful change. "Technology is required to change behavior," says Mr. Iseri. "It allows people to drive safer, save more money and eat healthier. Lo and behold, more people go to the gym because of their Fitbit." The same concept can apply to hand

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