Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, hopes technology will one day achieve what no other strategy has thus far: Increase the rate of hand hygiene compliance.
Haas, president of the Association of Professionals in Infection Control and Epidemiology, says it will need to be a small device that does not require healthcare professionals to add another step to their already busy routines. Perhaps it could be incorporated into a Fitbit or Vocera, the wearable intercom system.
“I would like to see it linked to something people already wear and are engaged with, such as a fitness tracker,” Haas says. “Ideally, it would be set up to provide a nudge in the moment. Often, people don’t recognize that they are missing an opportunity to wash their hands.”
A device like this would provide real-time monitoring and immediate feedback, so that staff members could complete hand hygiene before they touched the patient.
High-technology monitoring systems are available now, but most of the data on their efficacy comes from research studies. Whether they will work seamlessly in real life is not as clear, Haas says.
Compliance has stalled
Despite numerous interventions, hand hygiene compliance has plateaued in the last couple of decades. It’s estimated that hand hygiene compliance is about 40% on average. However, with a multipronged approach and a lot of attention, that rate can rise to more than 70% for extended periods of time, Haas says. Some of the new monitoring technologies report compliance rates of more than 90%.
“Unless we provide immediate, corrective feedback, the opportunity to change behavior is lost,” Haas says. “Humans are blind to their own behavior.” Most hand hygiene compliance strategies consist of:
• ensuring that sinks and hand sanitizers are available in convenient locations where healthcare professionals are providing patient care
• auditing hand hygiene compliance through direct observation, video cameras, or other sensors
• providing continuing education and reinforcement of appropriate hand-washing techniques.
There are many options for documenting hand hygiene observations, from pencil and paper to digital platforms that can be purchased or are free, Haas says. She and other infection control experts have developed a Google form that helps streamline documentation of hand hygiene observations. Hand hygiene observers can input their observations directly into a Google form from their phone or tablet, and the analysis can then be completed using the R statistical package.
“Part of the burden of hand hygiene monitoring is watching and then writing what you observe on paper,” Haas says. “The concept is that you can collect the observations on your phone or tablet, and that cuts out the transcription. Anyone can do the observation from anywhere, and the data goes to a central spreadsheet.”
Strictly following hand hygiene compliance can be particularly challenging in the OR environment, says Haas, who started her nursing career as an OR nurse. Whether in a hospital or ambulatory surgery center, OR staff typically don’t see patients after surgery, so they don’t see the direct impact of quality control methods, eg, whether patients eventually develop surgical site infections.
“This lack of feedback encourages a false sense of security that your actions don’t necessarily matter,” Haas says. “But every contact matters to the patient. Be mindful that in this fast-paced world, it is patient safety that is at the center of all these guidelines.”