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.


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