Healthcare News & Insights

What pandemic has taught us about importance of hand hygiene compliance

Never in my lifetime do I recall such a significant worldwide wake-up call on the importance of infection prevention. When COVID hit, nearly every person across the globe changed their hand hygiene behaviors seemingly overnight, and became more compliant. Rightfully so; hand hygiene has been cited as one of the single most important practices to reduce the spread of COVID and other viral illnesses.

Of course, this isn’t news to health systems. Hand hygiene has always been a foundational element of a sound infection prevention (IP) program. But, seven-plus months later, it’s important to ask ourselves: How are we doing in our efforts to protect patients and staff? Has COVID driven a meaningful increase in hand hygiene compliance levels inside hospitals? 

According to a study by The American Journal of Infection Control, hand hygiene compliance in the health care setting peaked at just above 60%, four weeks after the onset of the pandemic, before declining again. That’s quite a significant gap, considering the motivation for collective compliance has arguably never been higher.

Let’s face it: Compliance has long been a challenge in the industry. Various observational studies over the years show that when staff members are rushed and focused on imminent patient care needs, hand hygiene compliance can slip. We found this to be true in our 353-bed hospital and Level 1 trauma center, as well. Nobody intentionally skips washing their hands, but distraction and emergent speed of care are common realities.

A drive to improve hand hygiene compliance is what ultimately led us to implement an electronic hand hygiene compliance monitoring system hospital-wide in February 2019. Several weeks after implementation and training, we exceeded 90% hand hygiene compliance and were able to sustain that level on an ongoing basis. We saw our rate of healthcare-associated infections go down—including C. Diff. specifically. How? The system we use gives a gentle, real-time reminder when you haven’t washed your hands before approaching a patient zone. It pulls you back into the moment and keeps you compliant.

When COVID hit a year later, our IP team assessed the full spectrum of safety concerns related to the pandemic and we were relieved to already have implemented a system sustaining 90% hand hygiene compliance rates. Having the system in place allowed our IP team to focus on other, emerging needs during COVID. It’s not a set it and forget it program, but it replaces a lot of labor time. It’s one less IP process we have to directly have our hands on and worry about, which enables us to shift attention to education around PPE practices and other essential work.

Implementing a new IP program can require a lot of time and effort—something most don’t seem to have enough of, especially these days. So, in the interest of helping others who are evaluating and adopting new programs, I’ll share what we learned from the implementation of our electronic hand hygiene compliance monitoring program.  

  • Improved compliance requires full buy-in. Success requires a strong partnership between IP, the C-suite and clinical leaders. To gain buy-in from the C-suite, we collected data and built the business case to illustrate the ROI of truly being committed as an organization. Education is important to getting clinical leaders on board. Doctors, in particular, like to see the data and get feedback on how they’re doing. Make sure staff understand the intent isn’t to get anyone in trouble—this is about everyone partnering to keep each other safe.
  • Don’t rush – do it right. Change doesn’t happen overnight. Getting it right requires strong commitment and partnership. We leaned on our system provider’s partnership and service model to ensure our system was working well and met our facility’s unique needs. We also allowed time to track outcomes along the way and optimize based on our findings. We started with one unit and expanded after we saw success. 
  • Sustainable practices need to fit seamlessly within the workflow. Frontline workers’ focus is patient care. When a nurse or physician walks into a room they are thinking about the task at hand – whether administering a drug or rounding. Therefore, the most successful and sustainable solutions are subtle. Similar to the reminder we receive in our car if we haven’t buckled our seatbelt, a nudge can help build long-term habits. For example, our hand hygiene compliance system uses a badge that staff wear to communicate with two sensors. One sensor is under the bed and monitors the area around the patient and the other is in the soap or sanitizer dispenser. When staff follow the protocols, the badge flashes green to indicate that it is safe to interact with a patient; but if they forget, the badge flashes red and can be set to have an audible beep. Leveraging technology as a reminder gives staff added confidence that they can focus on their patients’ needs and will be brought back into the moment and reminded to practice good hand hygiene when they get busy.  
  • Collect data to demonstrate the true impact. Data holds people accountable. Look for a system that can track performance on an individual, department and hospital-level. Then identify the metrics that matter and create reports that are succinct and relevant. Make the data accessible so that staff can check their own reports and see the direct impact based on their compliance and how their efforts impact infection rates. Having access to individual staff data not only holds them more accountable but can serve as a useful tool if an outbreak occurs within your health system, as you can get to the source of the problem faster.  

COVID has been challenging for health systems, but it has underscored the importance of identifying gaps and opportunities for improvement in infection prevention. If we take the time to develop sustainable solutions, such as new hand hygiene compliance programs, we can come out on the other side stronger and safer than ever before.

Author: Molly Reagan is the interim vice president/chief nursing officer at North Memorial Health in Robbinsdale, Minn. She has previously served as the director of patient care and was instrumental in the successful rollout of the Ecolab Hand Hygiene Compliance Monitoring System. 

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