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37 Executive Briefing Sponsored by: s healthcare costs continue to pile up and superbugs raise new concerns, hospital leaders should look to button up their organization's approach to a seemingly simple task that continues to be a stumbling block for too many hospitals — hand hygiene. Hospital-acquired infections are a lingering and troublesome problem for healthcare facilities. Every year, Medicare cuts payments by 1 percent for hospitals that fall in the worst- performing quartile on hospital-acquired conditions, which includes patient infections with potentially deadly pathogens like methicillin-resistant Staphylococcus aureus (MRSA). In 2017, CMS penalized 751 hospitals for poor performance on these measures, reducing Medicare reimbursements for fiscal year 2018. The burden MRSA places on hospitals extends beyond CMS penalties. The drug-resistant bacteria was associated with 80,000 infections and 11,285 deaths in 2011, according to the CDC. Estimates cited by PEW Charitable Trust suggest the annual cost of treating hospitalized MRSA patients falls between $3.2 billion and $4.2 billion. Hospitals can better protect their patients and their bottom lines from potentially deadly infections with effective, technology-supported solutions designed to improve hand hygiene compliance. Hand hygiene can reduce infection rates — when staff comply A CDC-backed 2016 study of an 835-bed hospital identified a link between improved hand hygiene compliance and lower rates of hospital-acquired infections. When the hospital improved hand hygiene compliance by 10 percent, the facility saw 197 fewer infections and 22 fewer deaths over a 17-month period. The improvements correlated to an estimated $5 million in savings. While the benefits of strong hand hygiene are significant and demonstrable, achieving high rates of compliance among providers remains an obstinate challenge for many hospitals and health systems. The CDC estimates some healthcare workers initiate hand hygiene less than 50 percent of the time they should. To boost compliance, many hospitals rely on direct observation, which involves individuals monitoring hand hygiene practices of providers. While shown to have some positive influence over compliance, direct observation has several shortcomings that make it a relatively unreliable method by which to achieve excellent and sustainable hand hygiene adherence in the long-term. For one, employing individuals to manually observe handwashing practices is labor-intensive and costly, especially for small or mid-sized organizations with limited resources. Another notable challenge is the Hawthorne effect, or the occurrence of altered behavior when an individual is aware he or she is being observed. When hand hygiene auditors monitor compliance, researchers suspect the Hawthorne effect may artificially inflate compliance rates. A 2014 study in BMJ Quality & Safety found providers were significantly more likely to use hand sanitizer dispensers visible to direct observers versus dispensers that were not visible to observers. This suggests that for hospitals to permanently improve hand hygiene compliance across the board, they'd have to employ a small army of direct observers to patrol the facility at all times. "Hand hygiene event rates were approximately threefold higher in hallways within eyesight of an auditor compared with when no auditor was visible, and the increase occurred after the auditors' arrival," concluded the study's authors. "This is consistent with the existence of a Hawthorne effect localized to areas where the auditor is visible and calls into question the accuracy of publicly reported hospital hand hygiene compliance rates." The good news is hospitals no longer have to rely on direct observation alone to achieve top-tier hand hygiene compliance rates. Healthcare leaders can leverage the latest in advanced electronic compliance monitoring technology designed to capture every hand hygiene event and deliver real-time feedback to providers in order to help keep harmful pathogens out of the patient zone. Protect the patient zone As part of its comprehensive hand hygiene program, Ecolab — a global provider of water, hygiene and energy technologies — offers a highly accurate compliance monitoring system. The system electronically monitors hand hygiene engagement through an electronic badge worn by providers. Importantly, the patient bed is also monitored, creating a patient zone that interacts with provider badges to ensure hygiene compliance. This element is unique to the Ecolab system. When a provider enters a patient room and engages in hand hygiene, a light on the badge will turn green indicating it's safe to interact with the patient. If the provider does not appropriately initiate hand hygiene, the badge light will turn red upon entering the patient zone. The badge can also be programmed to emit an audible chirp or beep to remind the provider to wash or sanitize his or her hands. "It's like the reminder when you get in your car to put on your seatbelt," says Kathleen Burzycki, senior marketing manager with Ecolab. "That reminder lets you know when you're being unsafe in a car, and this reminder lets providers know when they're being unsafe around a patient. We're changing behaviors right at the point of contact." Beyond protecting the patient zone, the Ecolab compliance monitoring system generates robust data on provider hand hygiene performance. This information is transmitted to a dashboard, which generates reports on hand hygiene adherence that can be accessed directly or disseminated via email. These reports can encompass data from the whole system or drill-down to specific locations, dates, departments and even specific providers. These reports can also provide assessments of seven-day and 90- day compliance trends, as well as detailed information about the specific nature of missed hand hygiene opportunities, such as when they occurred in the care episode. Additionally, the system can generate individual report cards, so providers can benchmark their own performance both hospitalwide and within their own department. Ms. Burzycki says this system encourages hand hygiene compliance through positive reinforcement. With hand hygiene compliance, there's no such thing as 'good enough' A