Data becomes key in promoting proper hand hygiene

Story was updated March 12, 2018.

One of the most basic and easy tasks could be the best defense against the spread of healthcare-associated infections: hand hygiene.

Yet according to the Centers for Disease Control and Prevention, healthcare workers, on average, wash their hands less than half as often as they should.

Research shows there are many reasons why a healthcare worker doesn’t follow proper hand-hygiene protocols.

The worker might have too many items in their hands when he or she walks into a patient’s room. A sanitary dispenser or a hand-washing station might not be readily available before the staff member interacts with a patient. And sometimes a worker might simply forget.

Earlier this year, the Joint Commission announced it will issue a citation to a healthcare organization if during on-site visits a surveyor witnesses employees failing to follow correct hand-hygiene guidelines. Since 2004, the Joint Commission has made hand hygiene a requirement for accreditation.

Recognizing that healthcare organizations need help on this front, the accreditation body’s Center for Transforming Healthcare has a tool that helps hospitals and health systems pinpoint specific reasons why their employees aren’t washing their hands and provides training strategies to improve compliance.

Called the Hand Hygiene Targeted Solutions Tool, it was developed in 2010 along with help from clinicians at eight hospitals including Los Angeles-based Cedars-Sinai Medical Center and Houston-based Memorial Hermann. Over a two-year period, they tested ways to measure and assess hand-hygiene compliance as well as tactics to improve hand-washing rates. The hospitals identified 45 root causes for hand-hygiene noncompliance including improper use of gloves, hands full of supplies or empty soap dispensers.

“(Hand-hygiene compliance) is not a simple one-size-fits-all solution. It really takes some work to understand the causes (of noncompliance), but once you can understand your own root causes, you can get toward targeted solutions,” said Klaus Nether, executive director of high reliability product delivery at the Joint Commission.

Applying the tool

Sparrow Hospital in Lansing, Mich., began to use the Joint Commission’s tool early last year. It was free to use because Sparrow is accredited by the agency. Organizations that are not accredited by the Joint Commission have to pay a fee.


Select employees to be secret observers to record hand-hygiene compliance.

Allow front-line staff to view compliance rates and discuss the data as part of daily huddles and rounds.

Encourage staff to talk about reasons why they don’t or can’t comply with hand-hygiene protocols and come up with solutions as a team.

Sparrow began by enlisting non-clinical workers to be secret observers to watch clinicians and see whether or not they followed hand-hygiene guidelines while interacting with a patient. The observers then record the interaction into the tool either on a desktop or by using a smartphone app, which became available last September.

The observers also record what may have prevented the clinician from washing their hands.

Jeff Kay, the safety officer at Sparrow Health System who led the effort at the hospital, said that while the training is “very simple and straightforward” it’s “labor intensive” for observers to do this work and make it part of their work day.

Since last year, the hospital has logged “hundreds of thousands” of observations, which are analyzed to spot trends.

“You can slice your data a lot of different ways so we are able to identify very easily roles that might be struggling with compliance,” Kay said.

For instance, some units shared a common problem—clinicians forgetting to wash their hands after entering a room because their hands were too full. One solution: designate an area near the door where the clinician can place items and sanitize their hands.

A lot of the improvement work was unique to each unit. Sparrow Hospital selected leaders on every unit to spearhead solutions based on what the analysis identified as problem areas. For units that had similar issues, they worked together to discuss ways they can implement solutions.

Sparrow’s hand-hygiene compliance rate over a one-year period increased to more than 80%.

The gains are in line with successes other hospitals have had using the tool. For example, Memorial Hermann improved its compliance rate from 58% to 95.6% over four years and adult central line-associated bloodstream infections in the intensive-care unit fell by 49%.

Some 789 healthcare organizations in the U.S. and internationally are currently using the hand-hygiene tool.

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