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INFECTION CONTROL
staff about the importance of proper skin care in the workplace, including training in the right techniques. This is far more effective as an ongoing conversation, rather than a one-off event. Hospitals should strive to create a culture of effective hand hygiene and skin care to make their programme work. The Government’s plans to improve transparency on infection control by forcing hospitals to publish staff hand hygiene figures is a step in the right direction. Later this year, hand sanitiser usage will have to be monitored and reported to the Care Quality Commission (CQC), enabling it to scrutinise hand hygiene compliance and drive up standards. However, uncertainty remains regarding the method of monitoring that underpins the figures, as this could be through manually checking dispensers, electronic monitoring or by other means. This is not merely a superficial question: ensuring accurate and timely data requires an appropriate method of data collection, without which the Government will not achieve its objective of infection reduction. Hospitals should be providing regular and objective feedback to staff on performance against agreed best practices. This should include monitoring compliance with their hand-hygiene procedures, and ideally with skin care practice. Regular auditing of hand hygiene is already a standard practice; however, recent work has shown, without doubt, that traditional measures for tracking hand-hygiene compliance are outdated and ineffective.10
Exploring effective methods for hand hygiene monitoring
Direct observation is the most common auditing method, with human observers directing monitoring staff behaviour as they perform their day-to-day duties to determine the healthcare facility’s compliance in line with the WHO’s ‘Five Moments’. This practice has severe limitations.
Programmes are typically conducted manually, with limited sophistication in the gathering or analysis of the data compiled. Some online auditing tools are becoming available, which is clearly an improvement, but does not overcome the fundamental flaws in this approach. First of these is the well-known ‘Hawthorne Effect’: staff know when they are being monitored and behave differently. As a result, observed compliance rates are artificial, giving hospitals a false reflection of actual hand-hygiene habits (and how to improve them). Often this method of reporting will only capture room entry and
One in 16 patients contracts a healthcare-associated infection (HCAI) while in hospital.1
exit events, which represent less than 49% of all hand hygiene opportunities. It can also overstate actual compliance by up to 300%.11 Secondly, and less well-studied, is the phenomenon of observer bias in further undermining the quality of data. Put simply, if auditors are not totally impartial or well trained, it is difficult for them to adequately audit hand-hygiene practice and identify opportunities for hand hygiene not taken. Thirdly, by using direct observation, it is impossible to gather sufficient data to adequately reflect true practice. Observers often monitor a given ward or unit for only 30 minutes or one hour per month, and it is very typical that such observations take place only during the day - not capturing practice during night shifts or weekends. Finally, hospitals just do not have the resources to overcome the other issues with direct observation. If staff are required to weigh or count cartridges used in hospital hand sanitiser dispensers, it creates a time- intensive task that will distract staff from their patients – without addressing the concerns of data accuracy or whether there’s enough data to support analysis.
Having the right hygiene products and equipment in place is an important step for hospitals to reduce the number of patients contracting an HCAI.
SEPTEMBER 2017
Through more efficient monitoring approaches, already-strained NHS bodies can make better use of healthcare workers’ time - assigning them to other pressing tasks that require their medical expertise.
Finding the way forward with technology
Technology will be the key to improving the level of care provided in healthcare environments – and preventing the spread of infections across hospitals. However, many institutions struggle to make the most of the solutions they bring in to tackle issues like hand hygiene compliance due to a lack of digital maturity.
Significant steps must be taken to improve the digital maturity of specific NHS Trusts across the UK. Digital maturity is assessed by examining a Trust’s readiness to take full advantage of their technology, the capabilities that the facility has, and whether it has the potential to enable new digital infrastructure. To improve digital maturity, NHS England has announced that it is looking to fund new “place-based” global digital exemplars. Professor Robert Wachter, MD professor and interim chairman at the University of California, recommended that the most digitally enhanced NHS Trusts must be hand- picked for funding in order to elevate them to “global exemplar” status. The end-goal is that the significant transformation from being digitally advanced to being an exemplar will encourage other NHS Trusts to step up to the
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