The guidelines for hand hygiene measures that should precede and follow patient encounters are well defined. Yet research shows that doctors, nurses, and other caregivers are pretty bad at adhering to them – and are only in compliance from 30 percent to 48 percent of the time, depending on which study is being cited.
Research has identified some of the factors that are predictors of poor compliance with hand hygiene measures. These are:
- Level in the professional hierarchy. Unfortunately, doctors are accustomed to high levels of autonomy and this sometimes makes them resistant to authority. They tend to have the worst adherence to hand hygiene.
- Type and intensity of patient care. One study found that compliance was highest in pediatric units and shockingly low in intensive care units. This seems to indicate that the patient’s need sometimes takes priority over hand hygiene – or that providers simply feel there isn’t time for handwashing in a high-pressure environment.
- Organizational deficiencies. These include issues like sinks and hand sanitizers that aren’t strategically located near the point of care or simply a hospital culture that does not emphasize patient safety.
While infection preventionists have always made efforts to educate staff about the importance of hand hygiene in preventing infection, the stakes have recently gotten higher: under new Medicare rules, hospitals will no longer be reimbursed for treating certain kinds of hospital-acquired infections that have been deemed preventable. At the same time, drug-resistant super-bugs are on the rise and are likely to cause complications that are expensive and problematic to treat. With the bottom line now under siege, preventionists are getting innovative. A recent New York Times article reported on a variety of efforts to modify hand hygiene behaviors – including video surveillance:
At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.
The results of a pilot study to gauge the effectiveness of this program were impressive:
North Shore’s study, published in the journal Clinical Infectious Diseases, found that during a 16-week preliminary period when workers were being filmed but were not informed of the results, hand-hygiene rates were less than 10 percent. When they started getting reports on their filmed behavior, through electronic scoreboards and e-mails, the rates rose to 88 percent. The hospital kept the system, but because of the expense, it has limited it to the intensive care unit, where the payoff is greatest because the patients are sickest.
Other hospitals are adapting their own innovative strategies, like using the “secret shopper” approach to monitor caregivers’ hand hygiene habits. An unidentified staff member, sometimes a medical student, randomly observes whether providers are washing their hands at appropriate times and the data is then used to generate a monthly report card for each unit. Once providers realize they may be under observation at any time, they often become more compliant.
Yet another approach involves wireless sensors on soap or sanitizer dispensers that communicate electronically with a beacon in the provider’s badge. When a provider approaches a patient bed without having washed his or her hands, the badge vibrates soundlessly as a reminder to clean up first. The information is also transmitted to a database in the infection control department, so preventionists can follow-up with providers who are routinely non-compliant.
If you’re interested in planning, implementing, and evaluating infection prevention and control measures, consider making this field your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to MSN degree with a specialization in infection control from American Sentinel University, an innovative, accredited provider of online nursing degrees.