Hand Hygiene: What to Consider When Increasing Compliance

By Melissa Berrios, RN, BSN

The rate of healthcare-associated infections (HAI) has sharply increased after years of decline, a change that is largely attributed to COVID-19. Higher volumes of sick patients in hospitals adversely impact HAI rates, especially during a COVID-19 surge. In addition to impacting the health of millions of individuals and their families, HAIs and COVID-19 are expensive, costing healthcare systems billions of dollars. According to the American Hospital Association, U.S. hospitals and health systems experienced a loss of more than $200 billion in expenses and revenue just within the first year of the pandemic.

While protecting the health and well-being of patients and staff is the top priority for healthcare facilities, it can also be a significant challenge. Even though hospitals use protective measures to reduce the transmission of germs, HAIs and COVID-19 continue to threaten facility occupants.

This issue is far too complex to solve with a single solution, but implementing an electronic hand hygiene monitoring system can help. Unlike manual data collection, automated monitoring solutions are not prone to human error or the Hawthorne effect—the phenomenon wherein people temporarily change their behavior because they know they are being watched. An automated system also eliminates the training and labor costs associated with manual observation. Furthermore, automated systems directly improve hand hygiene policies and staff education by highlighting strengths and weaknesses of individual roles and units, as well as the facility’s overall compliance. Let’s look at what to consider when selecting an electronic hand hygiene system.

Why implement an electronic hand hygiene system?

Contaminated hands are a primary vehicle in transmitting germs and viruses, which means hand hygiene remains imperative to protect patients, staff, and visitors. According to the Centers for Disease Control and Prevention, hand hygiene is one of the most effective tools to mitigate the impact of HAIs and COVID-19—a finding that should encourage hospitals to revisit their infection control practices.

Hand hygiene only works when a facility and its staff implement and follow the proper protocols. Compliance for hand hygiene in most hospitals is less than 50%, according to a 2020 Patient Safety Movement report. Another industry report noted that burnout among nursing staff increases with lower hand hygiene compliance rates, a crucial consideration as burnout among healthcare professionals reaches an unprecedented level.

Effective monitoring practices are necessary to ensure compliance. Many hospitals use manual observation methods, but this approach only takes a snapshot of daily hand washing activity and usually excludes data from holidays, weekends, night shifts, and understaffed units. An electronic hand hygiene solution automatically monitors and reports all possible hand washing events and can drive improvements in compliance, identify areas for growth, and reduce rates of HAIs. Due to these factors, organizations like The Leapfrog Group and The Joint Commission indicate a strong preference for the use of electronic hand hygiene monitoring systems that are implemented according to evidence-based principles.

Benefits of automating hand hygiene

Healthcare administrators and infection preventionists (IP) have implemented hand hygiene policies and compliance tracking procedures for decades, but not all healthcare facilities have been equipped with the latest technology. Many facilities still use a manual process as the gold standard in monitoring hand hygiene. In this process, trained monitors observe and then report on a segment of hand hygiene events throughout the hospital. The manual process is a huge burden on IP teams; an electronic system would free up valuable time for IPs to work on preventing, detecting, and treating HAIs. In addition to being labor-intensive, manual observation is expensive and only covers a small sample—1.2% to 3.5%—of hand hygiene events.

Compliance results are often inaccurate enough that IPs know they don’t truly reflect hand hygiene activity. Observation data is often skewed and overstated as auditors influence the behavior of observed staff, who temporarily change their hand washing habits to conform to protocols (the Hawthorne effect) and thus trigger higher than actual compliance rates. Manual methods also are prone to human error, manipulation, and delays in reporting information.

Electronic monitoring offers a more comprehensive and effective method of monitoring hand hygiene events throughout a healthcare facility, providing an unbiased view of hand washing activities to identify compliance and noncompliance. Electronic monitoring can also help facilities establish best practices for hand washing habits. Some advanced systems can offer real-time reminders to perform hand washing before a patient interaction occurs by determining if a staff member has been in the room for a predetermined amount of time without activating a soap dispenser.

Going beyond hand hygiene monitoring

Various electronic hand hygiene monitoring solutions offer diverse capabilities for documenting activities and reporting findings. A real-time location system (RTLS) solution, for example, goes beyond tallying hand washing events to monitoring individual behavior according to set protocols. Just-in-time reminders also help to increase compliance with every patient interaction, reducing the spread of infection and increasing safety.

The technology behind RTLS includes radio-frequency identification (RFID) location-enabled badges that digitally connect with hand hygiene sensors applied to (or embedded within) dispensers, sinks, and hand washing stations. An RTLS-based hand hygiene monitoring solution supports rules for specific rooms, such as using soap vs. sanitizer or time frames for expected hand hygiene compliance upon entering a room. It detects both the presence of a badge and the use of a dispenser, instead of just a staff member’s presence.

An electronic system’s most powerful feature, however, is its detailed analytics. Collected intelligence is automatically shared through a dashboard and reported to the IPs and other hospital administrators who can audit hand hygiene events by unit, role, time of day, room, and individual to review compliance, analyze trends, and pinpoint areas needing improvement. These reports can be automatically delivered on a custom schedule and offer real-time awareness of operations, identifying the need for additional interventions (e.g., a change in clinical workflow or an increase in staff training) where compliance falls short. The reports should also be used to celebrate high performance, as they provide opportunities to collect and share best practices across the health system.

Ensuring success with an RTLS-based hand hygiene system

A medical center in Denver improved its hand hygiene compliance rates by 75% with CenTrak’s RTLS-based hand hygiene compliance solution. In the past, the medical center utilized a manual process that only documented a few hundred observations monthly during regular business hours in the 500-bed facility. With the electronic hand hygiene monitoring system, information is gathered on 100% of hand washing events, enabling the hospital to continuously audit facilitywide compliance protocols and processes. In addition to generating compliance reports to support Joint Commission requirements, the system’s analytic capabilities mapped areas needing additional education. Meanwhile, a healthcare facility in Georgia integrated the same CenTrak solution and improved hand hygiene compliance by 130%, now consistently reaching compliance numbers that are among the best in the nation.

Automated monitoring solutions can help hardwire hand hygiene best practices in staff, increase compliance with hospital policies, and mitigate the impact of HAIs. Getting a handle on hand hygiene will boost the patient care experience, improve the delivery of care, and help IPs focus on the proper areas for growth while simultaneously improving hospital revenue.

Hospitals that embrace enterprise location technology for their hand hygiene compliance systems can gain control and visibility throughout their facilities to reduce the threat of HAIs. As a bonus, using an RTLS solution as a foundation enables hospitals to expand their operational capabilities in the future, including contract tracing, staff duress alerts, nurse call automation, and asset management.

Melissa Berrios, RN, BSN, is a clinical educator at CenTrak, the market leader in locating, sensing, and security solutions for the healthcare industry. CenTrak has helped more than 2,000 healthcare organizations around the world build a safer, more efficient enterprise. For more information, visit www.centrak.com.