Becker's Clinical Quality & Infection Control

6 HAND HYGIENE How Combining Traditional Hand Hygiene Initiatives With High-Tech Solutions Can Improve Compliance By Heather Punke N early 800 hospitals received word in December they would face Medicare reimbursement cuts in fiscal year 2017 because of high infection rates under the Hospital-Acquired Conditions Reduction Program — but Riverside Medical Center in Kankakee, Ill., hasn't been penalized under the HAC Reduction Program since the pro- gram started in 2015. A large factor of Riverside's low infection rates is its high hand hygiene compliance, accord- ing to Michael Mutterer, BSN, RN, senior vice president and CNO of Riverside. But the hos- pital didn't always boast high hand-washing compliance. When using the direct observation method, the hospital recorded close to 100 percent hand hy- giene compliance. But when it installed an elec- tronic hand hygiene monitoring program and used it instead of direct observation to track compliance, Riverside found its compliance rate was actually only about 57 percent. "It was very shocking," Mr. Mutterer says. "I think initially we didn't believe the data … Without a shadow of a doubt we had a false sense of compliance." So Mr. Mutterer and other hospital leaders dug in and found the data was correct — the elec- tronic hand hygiene monitoring program was just much more thorough than direct observa- tion had been. For instance, direct observation is subject to the Hawthorne effect and mostly focused on compliance with gel-in, gel-out, in- stead of the World Health Organization's Five Moments for Hand Hygiene. Aer realizing clinical staff had much im- provement to make on hand hygiene com- pliance, Riverside Medical Center officials jumped into the task of raising the level of compliance with the help of the electronic monitoring system from DebMed. e hospital deployed some well-known hand hygiene improvement strategies, such as hang- ing hand hygiene posters around the facility to remind nurses and physicians to wash their hands, instituting nurse champions to serve as "cheerleaders for hand hygiene" and including daily reminders of WHO's Five Moments for Hand Hygiene during daily unit huddles. However, Riverside added two more unique or high-tech hand hygiene improvement initiatives to the old standbys that, when combined, helped raise compliance from 57 percent in December 2013 to 79 percent in September 2015. Making hand hygiene a priority for all — especially senior leadership. Riverside uses a leadership evaluation management tool to align leaders throughout the system on the same goals. As part of the hospitalwide hand hygiene focus, hand hygiene compliance is on the LEMs of Mr. Mutterer as well as the CEO, the CFO and unit managers. "From the CEO down, this is an important indicator that we are monitoring," Mr. Mutterer says — and the electronic system is what allows them to do that monitoring. Sharing unit-level data transparently. Data on how units are performing on hand hygiene compliance is shared with leaders through their LEMs. at data allows for recognition of a job well done or a push in the right direc- tion when one is needed. For instance, Mr. Mutterer and other senior leaders get a weekly report as to how well indi- vidual units are complying with hand hygiene protocols. ose reports allow Mr. Mutterer to reach out to unit leaders to give them a shout- out for great compliance or offer support to managers whose units are struggling. Mr. Mutterer notes the data at Riverside isn't used in a punitive way, but rather as an indi- cator of who needs more support. "On a unit level, we rally the troops," he says. "[We're] able to focus on and improve overall compliance by looking at where do we have is- sues and where do we have great compliance. e mangers of units doing well huddle with the ones that are struggling … [they] wrap their arms around people in the units that are struggling." n Bedside Hand Hygiene Improves When Extra Healthcare Workers Are Present By Anuja Vaidya A study published in The Journal of Hospital Infection in February examined factors affecting hand hy- giene compliance before entering the patient room and at the bedside. The researchers analyzed hand hygiene compliance and as- sociated factors with a radiofrequency identification-based, real-time, continuous automated monitoring system in an infectious disease ward. They tracked healthcare workers while performing routine care over 171 days. The main outcome measures were hand disinfection before entering the room and before entering the patient zone, which was defined as the zone surround- ing the patient's bed. The study shows bedside hand hygiene is improved when one or two extra healthcare workers are present in the room. Additionally, of 4,629 hand hygiene opportunities, 16.5 percent were associated with compliance before entering the patient room; 6.1 percent were associated with com- pliance in the patient zone or by the bedside; while 77.4 percent were not associated with compliance. n

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