Hand hygiene
hospital data on safety and quality to push the healthcare industry forward. Leapfrog’s bold transparency has promoted high-value care and informed healthcare decisions and helped trigger giant leaps forward in the safety, quality, and affordability of US healthcare. Leapfrog’s surveys and assessments are typically voluntary for hospitals. Hospitals choose whether to participate and disclose their safety and quality data. This voluntary approach contrasts with mandatory reporting and accreditation processes in other standards around the world.
Over 3,000 Hospitals Safety Grade Scores
are published twice per year. These are in the format of simple letter grades (A, B, C, D, or F), based on hospitals safety performance. Behind this Grade is a series of calculations based on a number of criteria. By distilling the data into an easily recognisable Grade score, the Hospitals, Patients and Health Insurers have an easily identifiable way of assessing the Safety Standards within each specific hospital.
Prioritising patients Leapfrog’s primary mission is to provide transparency and information to consumers (patients) about the safety and quality of healthcare services. It is not a governmental agency, accrediting body, or regulatory authority. This independence allows them to take a consumer-centric approach to evaluating healthcare quality. The Hospital Safety Grade scores are publicly
displayed online under Leapfrog’s “How Safe is Your Hospital” search. This gives patients easy access to a variety of quality and safety metrics which allows viewers to drill into the detail behind the grades (see fig. 1). While the Leapfrog Group focuses on providing patients with easily understandable safety grades and promoting transparency, UK healthcare standards encompass a broader range of quality and safety measures. These are enforced by government bodies and regulatory agencies. For example, a noteworthy strategy in the UK
is the ‘gloves off’ campaign. Overuse of gloves is a significant issue in both the US and UK, with 60% of glove use being inappropriate. It is reported that hand hygiene compliance of healthcare workers wearing medical gloves is much worse than when medical gloves are not worn. Wearing gloves also correlates with lower hand washing rates before and after patient contact.7
The ‘Gloves Off’ campaign addressed
by the Lead Nurse for Infection Prevention and Control and two Lead Practice Educators at Great Ormond Street Hospital NHS Foundation Trust (GOSH) focused on the over-use of non- sterile gloves through education and training. This has improved patient safety and staff are now following evidence-based practice rather than wearing gloves out of habit.8 Both approaches aim to enhance patient safety and improve the quality of healthcare services, but they do so within their respective healthcare contexts. There is no doubt that both countries could learn a thing or two from each other’s strategies.
Electronic monitoring Monitoring hand hygiene compliance and
providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement strategies. Observational surveys conducted by trained personnel are currently considered the “gold standard” method for establishing compliance rates, but they are time-consuming and have many shortcomings. 9 Electronic hand hygiene monitoring systems
offer several advantages over traditional direct observation methods for monitoring and improving hand hygiene compliance in healthcare settings. These include, but are not limited to objective and unbiased data, real-time feedback, large-scale data analysis, improved quality improvement initiatives, mitigation of the Hawthorne effect, and time efficiency. Although the technology is a great expense originally, it has proven to have a positive impact with better hand hygiene compliance results. Electronic hand hygiene monitoring systems
are used in both the US and the UK to enhance hand hygiene compliance in healthcare settings. While the basic principles are similar, there are differences in adoption rates, regulatory oversight, integration with other systems, and the extent of data analysis depending on the specific healthcare facility and the healthcare system’s structure in each country. However, there is a much lower adoption rate of electronic hand hygiene monitoring systems in the UK compared to the US. The Leapfrog standard encourages facilities
Fig 1. Leapfrog Hand Hygiene Grade 54
www.clinicalservicesjournal.com I March 2024
to adopt a multimodal approach to hand hygiene. However, it places significant emphasis on the importance of monitoring and feedback. A controversial element is the requirement for hospitals to collect compliance data on 200 hand hygiene opportunities each month in each patient care unit. Following challenges
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