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16 INFECTION CONTROL & PATIENT SAFETY A Culture of Support: 4 Ways to Improve Hand Hygiene Compliance By Brian Zimmerman A s healthcare embarks onward through the era of value-based care, hospitals are under mounting pressure to reduce the spread of healthcare-associated infections to improve out- comes and avoid fiscal penalties. As antibiotic resistance becomes increasingly difficult for healthcare organizations to mitigate, com- prehensive infection prevention programs are necessary for both the financial wellbeing of a hospital and the health of patients. During a Nov. 17 webinar sponsored by Ecolab — a global provider of water, hygiene and energy technologies — Linda Homan, RN, senior manager of clinical and professional services with Ecolab's healthcare division, discussed the importance of compliance with hand hygiene and environmental hygiene protocols to the success of comprehensive infection prevention programs. Additionally, Ms. Homan examined human behavior models that influence compliance, as well as unique measures that can provide a broad look at hospital-wide hand and en- vironmental hygiene compliance. Multiple studies have confirmed the efficacy of hand sanitizers, en- vironmental disinfectants and sporicides in eliminating pathogens like Clostridium difficile and methicillin-resistant Staphylococcus au- reus. Still, preventing these pathogens from infecting hospital patients is a major challenge for many infection prevention programs. e success of such programs is predicated almost entirely on one factor — provider compliance. "We've shown that hand sanitizers and disinfectants are effective, so what is the challenge that we have?" asked Ms. Homan, during the webinar. "Why do we still have a problem? In many cases it's because of compliance, or human factors or human errors." 1. Promote. According to Ms. Homan, to properly promote compli- ance among providers, it is important to understand some of the hu- man motivations influencing compliance. According to one well-ac- cepted social cognitive model-the Health Belief Model, motivations to act include: • Perceived susceptibility: is is the individual's perception of the likelihood that failing to comply with infection prevention pro- tocols will result in an infection for either him or herself or the patient depending on the situation. • Perceived seriousness: A caregiver's interpretation of the seri- ousness of the outcome to the patient or caregiver if they are not compliant. • Cues to action: is describes how providers react to the strat- egies employedto encourage compliance, e.g. hand sanitizer lo- cated at the point of use • Perceived benefits: is is the caregiver's opinion of the ability of the advised action to reduce the risk or seriousness of impact • Perceived risks: ese are the tangible and psychological costs of taking the advised action • Self-efficacy: Compliance is influenced by a provider's confi- dence in their ability to complete the action they are being asked to do. • Social pressure: is is a provider's perception of pressure gen- erated from the social makeup of an organization. Will they be held accountable for compliance? • Intention to perform: is is a caregiver's readiness or willing- ness to perform the desired behavior Regarding the behavioral models, Ms. Homan said, "If you think about it, we're balancing this every day in healthcare. Not only for our own health, but for the health of our patients...we have to be thinking about how we can impact those beliefs, how we can remove the barri- ers from those perceptions and try to make it easier for people to make the right decision." 2. Improve. Some traditional methods shown to help encourage compliance with infection prevention measures among staff include motivational programs, administrative measures and training initia- tives. For a motivational measure, presenting staff with real-life, per- sonal stories regarding the human cost of HAIs can make an emo- tional appeal to providers to improve compliance. Administrators can also play a key role in improving compliance by being vocal advocates themselves. If employees understand directives are coming from the top down, they may feel more compelled to comply with them. Con- sistently retraining employees regarding hygiene best practices and systemwide benefits of compliance helps maintain and improve com- pliance levels among staff, as well. Currently, an increasing body of evidence points to behavior modifi- cation techniques, like posting signage designed to address health be- liefs in strategic locations throughout the hospital, as an underutilized and viable method of boosting infection prevention adherence. For instance, a study published in the journal of Health Psychology in January 2016, found posting the image of man's eyes over the sanitizer dispensers boosted hand hygiene compliance by 33 percent. is im- age may invoke social pressure to promote compliance. 3. Measure. To properly measure hand hygiene, every hospital is required to implement a program in accordance with the recommen- dations of either the CDC or the World Health Organization and set goals for compliance improvement. Hospitals have several different options to consider when monitoring compliance. "Don't blame or punish people, but use it as a learning opportunity to change the process, to change the workflow." – Linda Homan, RN