many health care facilities have seen improvement due to perseverance and persistence as well as newer products and easier access to products, compli- ance rates across the board, remain at approximately 50 percent overall.” Segal recommends that facilities

comply with either the current Centers for Disease Control and Prevention (CDC) hand-hygiene guidelines or the current World Health Organization (WHO) hand-hygiene guidelines. Over the last couple of years, hand

hygiene has become more of a focal point for accreditation surveyors since the endoscope infection broke across the country, says Alice Heiser, direc- tor of nursing/quality improvement coordinator at The Reading Hospital SurgiCenter at Spring Ridge in Read- ing, Pennsylvania. “The Centers for Medicare & Medicaid Services now has a whole section devoted to hand hygiene requirements, complete with survey worksheets,” she says. “They just want to make sure that we are fol- lowing best practices.” ASCs traditionally assess compli-

ance by direct observation where ASCA Board member and administrators and/ or directors of nursing assign staff mem- bers to “secretly” observe others, also known as “secret shoppers” or “known observers,” Segal says. “Staff members that are aware who the observers are tend to change their behavior when they know they are being watched,” she says. “This is known as the ‘Hawthorne Effect.’” The surveyors also want to see if you are monitoring hand hygiene in your ASC, says Cindy Young, RN, CASC, ASCA Board member and administra- tive director of Surgery Center of Farm- ington in Farmington, Missouri. “We have a secret nurse monitoring

hand hygiene in our ASC,” she says. “I switch up the secret nurse posi- tion every month so everybody gets to share the responsibility and look out for each other.”


Hand Hygiene Training through ASCA

ASCA will add a new program titled “The Importance of Hand Hygiene Compliance” to its online Regulatory Training Series this fall. For more information, go to TrainingSeries.

Young has hung signs designed

by the CDC and WHO (like the one on page 11) throughout her facility to remind staff how to wash hands and prevent germs from spreading. “You have to educate your staff on hand hygiene constantly,” she says. “If we find a problem, I address it with the person. We also discuss it in staff meet- ings once a month.” Heiser has a hand hygiene team that

works in the preop and postop areas and the operating room (OR). “They watch as the nurses and doctors provide care to patients and do hand hygiene,” she says. “My ‘spies’ watch for those certain hand hygiene opportunities. I require them to do at least 30 observa- tions a quarter, sometimes more. Some- times staff forget, and then, we re-edu- cate and move forward from there.” Educating and re-educating staff is

key to staying on top of hand-hygiene requirements, Heiser says. “Do it when a lapse happens,” she says. “Give your staff the opportunity to correct them- selves. I use the occasion of a staff meeting to review lapses. Hand hygiene opportunities, before gloving, seem to be forgotten the most. I also post com- pliance graphs quarterly on our quality improvement boards for all to review.” The quality improvement boards are two bulletin boards that she uses to post graphs, notices, etc., related to infec- tion prevention, quality improvement, benchmarking and other items of inter-

est to employees and physicians at the ASC, she says.

Heiser does an annual staff survey on the products that her ASC uses for hand hygiene because if the products are not good, the staff won’t use them, she says. “You have to find out if they don’t know about the opportunity or if they don’t like the product,” she says. “You can’t fault them if they are not being compliant without knowing the reason why.” Over the course of the past few years,

several companies have developed elec- tronic hand-hygiene monitoring systems that appear to be more reliable and accu- rate than observers but are very costly, Segal says. “However, despite the costs, many health care facilities have begun to calculate the benefit and have introduced them into the facilities. Infection preven- tionists agree that electronic monitoring increases compliance because the staff members know that they are being mon- itored 24/7 without having a colleague secretly watching them.”

Maintaining compliance requires a multi-disciplinary approach with “buy- in” from the administration team to the front-line staff, she says. “Every depart- ment is responsible for ensuring that staff members, including the medical staff, practice strict hand hygiene as per written guidance and policies,” she says. Historically, it seems the physicians

are scrutinized more when it comes to hand hygiene compliance. “It can get aggravating when a surveyor dings you because a physician did not foam up after taking off his gloves in the OR, although he walked straight to the preop area and did foam up before he talked to the next patient,” Young says. Despite the challenges, Heiser says, she has seen improvements amongst both nurses and physicians. As nurses put more emphasis on the need for consistent hand hygiene for themselves, they also get bet- ter at speaking up and reminding the phy- sicians to wash their hands.

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