INFECTION CONTROL Compliance technology to help measure human factors in healthcare


The importance of good hand hygiene and its positive impact on patient outcomes and safety cannot be underestimated, and has been an accepted fact for many years. When it comes to healthcare, the intention – to reduce the incidence of healthcare-associated infections (HCAIs) – can certainly be achieved by improving the results – i.e. increasing levels of hand hygiene compliance among healthcare workers.


Several studies have demonstrated an association between a reduction in HCAIs and increased hand hygiene compliance rates,1,2


so evaluation is already playing a


crucial role. However, the debate about how best to monitor hand hygiene compliance levels – put simply, how often healthcare workers, nurses and medical staff wash their hands – is beginning to gain some real momentum.


Direct observation has traditionally been the most popular way for hand hygiene compliance to be measured, and there is still a place for this. However, this can be labour intensive and behaviour might be altered when healthcare workers know they are being observed – a temporary behaviour change known as the Hawthorne effect. As in so many other walks of life, technology is now helping to shape mechanised alternatives that aim to improve processes and capture data automatically. GOJO Industries, Inc, in the US, presented a scientific research study at


the Association for Professionals in Infection Control and Epidemiology (APIC) annual meeting in Florida, entitled ‘Impact of Electronic Monitoring and a Hand Hygiene Environment Programme on Compliance Rates’. Led by Sarah Edmonds MS, senior clinical scientist at GOJO, the research was conducted on two units of an acute-care facility in Fort Worth, Texas, from June 2012 to October 2012. Edmonds said: “We were able to measure a significant increase in hand hygiene compliance over baseline during the intervention period, and also observed a sustained improvement in compliance for approximately two months post-intervention.”


This is encouraging and merits further close engagement with infection control nurses to help shape the compliance technology solutions that will work best for them. Some facilities may welcome systems that simply count each time a dispenser dispenses soap or sanitiser. However, for others, more complex solutions concentrating on the behaviour of identified individual care givers may be more appropriate.


The smartest systems and solutions will be the ones that adapt to individual circumstances, and to the inevitable changes in regulation and assessment criteria that will come in the future. Technology alone cannot effect a sustained change in hand hygiene compliance rates, but the data it can


The study observed 279 patients making more than 12,000 bathroom visits and found that hand hygiene only occurred 30% of the time.


Hand Hygiene was introduced. The World Health Organization’s strategy to improve hand hygiene includes undertaking hand hygiene at recommended moments exactly where point of care delivery takes place. This is where three elements come together: the patient, the healthcare worker, and care or treatment involving contact with the patient or his/her surroundings (within the patient zone). This requires that a hand hygiene


product, e.g. alcohol-based handrub, if available, will be easily accessible and as close as possible (within arm’s reach), where patient care or treatment is taking place. Point of care products should be accessible without having to leave the patient area. Availability of alcohol-based handrubs at the point of care is usually


APRIL 2015


achieved through staff-carried handrubs (personal use bottles), wall-mounted dispensers, containers affixed to the patient's bed or bedside table or to dressing or medicine trolleys that are taken into the point of care.


Staff engagement and


empowerment Engaging directly with infection prevention and control nurses to determine what is important for hand hygiene compliance improvement, in terms of their individual needs and those of the hospital or healthcare provider they work for, is vitally important – because they are the ones on the ‘front line’. Local factors and needs are something that GOJO takes into consideration, as how hand hygiene and other patient safety


provide will help by informing the other interventions and actions that can also drive improvements. This includes how we communicate the importance of good hand hygiene to healthcare workers, members of the public, and patients themselves; and how training programmes can be enhanced and made more relevant. It could also have a galvanising effect on research and development, inspiring the creation of ever more effective formulations and dispensing systems.


Debates will continue over the coming years, but one thing is certain: the healthcare community has the avowed intention to reduce HCAIs through improving hand hygiene compliance and there is a sustained effort to ensure that the technology delivers better results – continually and consistently.


References 1 Morgan, D.J. et al. (2012). Automated hand hygiene count devices may better measure compliance than human observation. American Journal of Infection Control. 40. 955-9.


2 Kirkland, K.B. et al. (2012). Impact of a hospital-wide hand hygiene initiative in healthcare-associated infections: Results of an interrupted time series. Quality Safety BMJ 21; 1019-1026. Retrieved March 19, 2013 from www.qualitysafety.bmj.com


measures are implemented will be influenced by demands faced within different hospital environments. Gill Byrne, senior infection prevention


and control nurse at Worcestershire Royal Hospital explained: “Our aim is to maintain good hand hygiene across the Trust, but also to enable staff to care for their hands so they are in good condition, as this helps them to do their jobs more easily, efficiently and effectively. “GOJO has given us lots of assistance and support, coming in to educate staff on hand hygiene and attend study days, as well as talk about skin health and the World Health Organization’s (WHO) ‘Five Moments for Hand Hygiene’.” Paying attention to points that may seem obvious but that, for many different reasons, do not happen in everyday practice is essential to improving patient safety. This ultimately requires a collaboration between staff at all levels. Changes are well within the realm of a committed team of staff and where they are not, the role of an organisation’s leaders in empowering and supporting them is crucial.


✚ THE CLINICAL SERVICES JOURNAL 65


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