Hand Hygiene Compliance- Learning from the U.S

Published on Thursday, 26 January 2012 14:27
Written by Donna Armellino

The latest Department of Health monthly statistics show that, for the first time since mandatory surveillance began in 2001, MRSA bloodstream infections across the NHS have been sustained at under 100 reported cases per month for the last six months

MRSA numbers are also continuing to decrease, with 86 bloodstream infections reported across the NHS in November 2011. On average there is now less than one MRSA infection per primary care trust (PCT) each month. Over in the US there is a similar determination to reduce pathogens such as MRSA and Cdiff .

One particular study, carried out at North Shore Hospital, Manhasset, New York, aimed to evaluate health care workers and hand hygiene compliance with staggering results. Editor, Scott Buckler sat down with Donna Armellino, vice president of infection prevention of North Shore – the fourth-largest hospital in the New York metropolitan area one of the cornerstones of the North Shore-LIJ Health System, to discuss the study and how technology has dramatically increased hand hygiene compliance.

Could you explain more about the study and why technology has been utilised by the Hospital?

Over an initial 16-week period, the hospital staff were monitored to establish a base rate of hand hygiene compliance without any feedback to the staff. Using a very strict definition of hand hygiene (requiring health care workers to perform hand hygiene before and after patient care within 10 seconds of entering and exiting the room, regardless if gloves were used), their rates were around 10%. The next 16-week period, staff received real-time feedback on their performance via LED screens mounted on the walls of the MICU and from management. Within weeks of providing feedback, the hand hygiene rate during the second period jumped to over 80%. During a subsequent 75 week maintenance period, a sustained rate of well above 80% was achieved.

Hand hygiene issues are Global, not just in a single health system of hospitals but throughout the world. One of the biggest issues has been sustaining the high standards of hand hygiene. This study utilized a third party auditing firm and technology which removed the human element and provided consistent measurement over time. Once the high rates of hand hygiene compliance were achieved, we have been able to use the technology to sustain the strong performance for over three years.  We have had staff monitor hand hygiene, however they cannot consistently remain focused on monitoring due to their work schedule and changing priorities based on events occurring in the hospital, so technology allows a constant recording of information.


Were hand hygiene rates high at North Shore before the introduction of this technology and did the improvements North Shore achieved have an impact on hospital acquired infection rates?


Using an internal auditing method, we believed that our hand hygiene scores were 60%.  This study focused on 17 beds within a medical intensive care unit (ICU) where infections were already very low, targeting central line related bacteraemia of around 0-3 per month or pathogens such as Clostridium difficile and methicillin resistant Staphylococcus aureus (MRSA) at 3-4 per month. We looked at MRSA and Clostridium difficile and we found a temporal relation between hand hygiene. When hand hygiene increased these pathogens decreased .

How has the study impacted on staff at the hospital and their approach to hand hygiene?


When the technology was put into the ICU and the 3rd party remote video auditing service was started, the initial rates of hand hygiene compliance were found to be less than 10%. When we informed the staff of the rates and the measurement rules we saw a rapid increase in hand hygiene performance to over 80%.  The current rates of hand hygiene compliance are roughly 90%, which represents the strongest value of the technology - sustainability.  We have now monitored a surgical ICU which when we started was below 30% and once we started informing them of their rates, they increased their hand hygiene rates to roughly 90% and continue to perform at these high levels.  Prior to installing the technology and LED boards, the hospital had utilized a hand hygiene monitoring methodology which led us to believe that we had ~60% compliance, but this method had limitations both in terms of accuracy and sustainability.  With the implementation of technology we have gained a long-term solution. We are now monitoring hand hygiene 24/7 and creating a competitive culture where staff are determined to keep their unit’s standards high.

This study is groundbreaking since it is an innovative way to assess specific actions, delivers information, and generates results. The technology has the ability to measure and modify staff behaviour towards hand hygiene whilst also allowing assessment of how staff are ensuring the risk for infection is decreased. The Hospital staff have welcomed the technology and understand the benefit it can bring to patients and the long-term care we deliver.

Further Information

North Shore University Hospital in Manhasset, NY, one of the cornerstones of the North Shore-LIJ Health System, is the fourth-largest hospital in the New York metropolitan area with more than 800 beds. With a staff of more than 3,000 specialty and subspecialty physicians, the hospital offers the most advanced care in all medical and surgical specialties, including cardiovascular services, cancer care, a state-designated Level I trauma center and one of the region’s largest emergency departments, orthopedic services, advanced neuroscience capabilities, maternal-fetal medicine and a full array of women's health services.

Arrowsight, a web-based Software as a Service (SaaS) provider, is the leading developer of remote video auditing services and patented software. Arrowsight has helped improve practices, compliance and employee morale in safety-sensitive industries, such as healthcare, food processing, food services, and manufacturing. For more information, visit www.arrowsight.com.

 

Comments   

 
0 #13 SecretaryMaria CannSecretary 2012-02-29 11:53
This technology is a step in the right direction. There are always flaws in hand hygiene audits, such as the 'halo effect' that is if you know you are being watched compliance will increase, therefore even if you have patients auditing, how can you be certain that when there are no observers everyone will be compliant. There have been some significant improvements in the numbers of reported infections, and as a patient charity we welcome this. There is still more to be done to drive infection rates to the lowest they can be, and this can only help to alleviate the misery that avoidable infections cause, also bringing efficiency savings in the long run, as infections come at a high price, both in terms of the human and financial cost.
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0 #12 ChairmanDerek ButlerChairman 2012-02-29 11:05
You know I agree with you, sadly funding the installation of this solution could be a problem for some who are shortsighted in looking at future savings, or simply they don’t understand the full cost of infection.

Actually that last statement could be unfair; maybe the person who is making this decision not to procure is simply following orders of priority or has never seen a loved one die from, or suffered themselves from a healthcare infection...or is it to save short term money at all costs. I do feel for the poor souls, who simply carry out these instructions, this is just part of the problem. With £20 billion to save they can be forgiven for making the odd mistake especially if they are not qualified clinically and have little understanding of the consequences of their actions.

They need to understand the Value for Money argument when it comes to (investing to save) in infection control. We think little of the costs of 5,000+ deaths per year in the UK and at least 300,000 more patients acquire non-fatal HCAIs socially and fiscally. Yes not just the agony and heartache caused but the lost beds space, the extra drugs, the suffering of the patient, the anxiety of the patient and their families, not to mention the staff themselves all wasted time and money, somewhat short sighted. All of this is avoidable including the money down the drain, ironic if the purse strings were the driving force at the front end.

The decision not to invest in infection control by those who simply don’t understand is simply throwing budget down the drain,

Do you disagree or agree?
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+2 #11 Senior LecturerJanet MigliozziSenior Lecturer 2012-02-17 12:18
I would echo the previous comments in that it is an innovative and clearly effective way of monitoring and improving HH practices. Whilst this technology's strength lies in its ability to help sustain longer term changes in behaviour/pract ice, I think convincing the budget holders that the initial financial outlay is worth it may prove a bigger challenge!
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+1 #10 Head of Physical Health Infection ControlNatalie MurphyHead of Physical Health Infection Control 2012-02-15 11:47
This is an interesting way of monitoring hand hygiene. Anything that reduces infection is positive. Will this be a cost effective way to maintain standards though?
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0 #9 DOMESTIC SERVICES MANAGERVicki ChapmanDOMESTIC SERVICES MANAGER 2012-02-02 15:24
Staff engagement on all levels is the key however it must be demonstrable via the Exec Board which in my experience is not forthcoming or only paid lip service to.
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+4 #8 Hospital Infection Prevention & Control Lead, Ward Sister - OrthopaedicsShieryl JonatasWard Sister, Infection Control/Tissue Viability Nurse Orthopaedic Ward 2012-02-02 11:41
Hand Hygiene is well embedded in the culture of Spire Bushey Hospital staff. We conduct quarterly audits and obtain regular feedbacks from our patients. Studies like this shows that going back to basics, increasing awareness and compliance of healthcare workers and it's application to our routine has proven to have high impact in reducing transmission not only of MRSA but in helping us to win our battle against a lot of multidrug-resis tant organisms.
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0 #7 IC LeadD Corrie 2012-02-01 15:31
The North Shore Hospital studyhas shown how educationcancha ngestaff behaviour towardshand hygiene. Regular hand hygiene audits can ensure compliance is maintained
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0 #6 Asst Local ManagerMargaret HicksonNHSP Assistant Manager 2012-01-31 14:53
Impressive statistics and effective hand hygiene, but let us not forget that it is not only hospital staff that need to be educated and monitored. patients and visitors are part of the hospital and should be educated and monitored too.
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0 #5 Junior Matron-Infectio n Control LeadFiona HindJunior Matron-Infection Control Lead 2012-01-31 12:13
Effective hand decontamination remains an essential part of reducing the transmission of infections and therefore any new innovation which supports sustainable compliance of effective hand decontamination is worthy of consideration.
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+1 #4 Surgical Services PGH & Group Decontamination Manager HCASaheba IaciofanoVoluntary 2012-01-30 12:44
I support this technology as it leads to better standards; it is also a better way of collecting accurate data using qualitative and quantitative data for benchmarking. The competitive nature of healthcare workers would ensure best practice; this would lead to less MRSA and better use of NHS funds.
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0 #3 Head Of OutpatientsLisa AllisonHead Of Outpatients 2012-01-27 21:17
a very interesting insight to the American hand hygiene. I am very glad I work in a regime where hand hygiene is audited on a regular basis so high standards are met.
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0 #2 healthcare assistantLiz CawseyLead For Infection Control 2012-01-27 20:11
I am proud to say our hospital have interally audited hand hygiene for a few years and we set targets. Complacency plays a part but continuing to do internal audits ensures that standards improve. The difficulty is getting consultants on board. This study is a great tool.
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0 #1 AcademicGrace FilbyAcademic 2012-01-27 16:36
Very impressive statistics with this new study. I hope the UK's NHS and Department of Health take note and encourage hospitals to do similar studies, especially at times when trainee doctors arrive on the wards, and for other new staff.

I think that less than 100 MRSA bloodstream infections per month is an improvement, but considering it is only an indication of the huge problem and there are many more patients with, for example, skin MRSA infections, there is still an enormous amount of work to be done in educating and monitoring staff. This new technology is to be welcomed since it looks to be very effective.
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