HANDWASHING
in the oncology unit was the introduction of the HyGreen EHHS, there was an overall 89% reduction in the HCAI rate. Furthermore, Lennox Archibald
reported that the estimated cost saving during the study period was significant. By lowering the number of infections from 4.5 per quarter to 0.5, using the average infection cost of $13,973,17 MCH saved $111,784. He concluded that electronic systems, with the ability to both monitor adherence and remind HCWs to perform hand hygiene when indicated, have an important role to play in efforts to reduce HCAIs.
ATP monitoring In Dublin, Ireland, the use of technology to improve hand hygiene technique and compliance has also been investigated by Mater Private Healthcare, with positive results. A poster presentation at the Infection Prevention Society annual conference, by Ann Higgins, showed that SystemSURE Plus – an Adenosine Triphosphate (ATP) monitoring system –
had a significant impact on hand hygiene compliance rates. The system, comprising a handheld luminometer and swabs, is designed to detect contamination. ATP is the universal energy molecule
found in all living cells. The combination of ATP with the enzyme luciferase produces light that can be measured in a luminometer. The amount of light is proportional to the amount of ATP and is expressed in Relative Light Units (RLUs). The greater the level of ATP, the higher the RLU value, the dirtier the hand. Measurement of ATP can be used: a) during induction training to show the effectiveness of good hand-washing technique and b) to monitor efficacy of hand washing by swabbing clean hands immediately after washing. Throughout 2010, monthly
departmental audits were carried out by the infection prevention and control nurse, at the Mater hospital. As part of these audits, staff of all grades were observed washing their hands. ATP swabbing was performed to assess organic
load on their hands after washing. Results were provided after 15 seconds and feedback given to the member of staff on how to improve hand hygiene technique. The results of the swabs were also fed back to departments as part of the monthly audits of hand hygiene compliance. Rates of hand hygiene compliance improved from 26% to 91% over the 18 month period, while hand hygiene technique also improved dramatically.
Camera surveillance In the US, a hand-hygiene research project found that camera surveillance also has a positive influence on hand hygiene behaviour. Reporting in the journal Clinical Infectious Diseases, Dr Bruce Farber, chief of infectious disease at North Shore University Hospital in Manhasset, revealed that that staff members’ hand-washing improved dramatically with electronic eavesdropping. Cameras are strategically mounted to
capture shots of doctors and nurses as they enter and exit the medical and surgical intensive care units. Each shift’s compliance is recorded in real time on LED monitors, which are prominently displayed. The monitor updates every 10 minutes, noting staff compliance. However, only positive performance messages are noted on the LED board. “Part of the criteria in this study,”
Dr Farber said, “was that all employees had to wash their hands before and after going into a patient’s room, and they had to do it each time within 10 seconds.” Before the electronic surveillance,
Dr Fowlie received the Hand Hygiene Champion of 2011 award from Julie Storr, vice president of the Infection Prevention Society (pictured right) with Natalie Vaughan (centre) who nominated him.
and also have a presence at the ICOG meetings. For the future, the Trust is investing in sinks and hand washing facilities in public areas like the hospital entrance and next to food outlets. Dr Fowlie and his team continue to set challenging targets and to strive for excellence – refusing to become complacent about hand hygiene.
Results From 2010-2011, Nottingham University Hospitals NHS Trust: • Had one of the lowest MRSA rates in the UK.
• Exceeded the target to reduce MRSA infections (five recorded vs 16 maximum target).
MARCH 2012
• Went more than 140 days without a hospital-acquired MRSA bacteraemia.
• Achieved hand hygiene compliance rates of 97%.
Schülke is now seeking nominations for this year’s awards and is inviting submissions (up to 250 words) on why an individual should be considered ‘Hand Hygiene Champion of 2012 (closing date for entries is 31 May.) Winners will be notified by 30 June and the award will be presented at the Infection Prevention conference, taking place at the ACC, Liverpool from 1-3 October 2012. Email your nominations to
handhygienechampion@schulke.co.uk
North Shore used the equivalent of a ‘secret shopper,’ by designating a staff member to note how well workers adhered to hand-washing rules. While the ‘undercover’ staff member reported rates of around 60%, an initial run of the electronic system revealed a rate of only 6.5%. However, following the roll-out of the electronic surveillance system, hand-washing compliance increased dramatically to nearly 90%.3
References 1 Hand Hygiene Champions the Cause of Infection Control, Frost & Sullivan, December 2011.
2 The utility of a novel electronic monitoring and reminder system for enhancing hand hygiene and improving outcomes in healthcare facilities, Lennox K. Archibald, MD, PhD, FRCP (Lond), FRCP (Glasg), DTM&H, hospital epidemiologist, Division Of Infectious Diseases, College of Medicine, University of Florida.
3 Results cited on North Shore’s website:
www.northshorelij.com/NSLIJ/li-hospital- monitors-workers-hand-washing
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