Joint Commission cracks down on hand hygiene

The Joint Commission will now issue a citation to healthcare organizations if during on-site visits surveyors witness an employee fail to follow correct hand hygiene guidelines.

The change, which went into effect Jan. 1, is intended to improve healthcare workers' compliance with proper hand washing. Poor hand hygiene of healthcare employees is considered a major contributor to hospital-acquired infections. About 722,000 hospital-acquired infections occurred in the U.S. in 2011 and about 75,000 people died with such an infection during their inpatient stay, according to the Centers for Disease Control and Prevention.

The Joint Commission has considered hand hygiene for accreditation since 2004. The accreditor requires healthcare organizations to have a hand hygiene program and to show steady improvement in compliance with the guidelines. A healthcare organization can implement guidelines established by either the CDC or the World Health Organization.

Given the fact that hospitals and health systems have been required to have a hand hygiene program for well over a decade, Joint Commission leaders felt it was time to extend the requirement to ensuring organizations have properly trained all employees to follow the program in their day-to-day workflow, said Mary Brockway, director of clinical research and standards at the Joint Commission.

"We felt this was an appropriate time now to make that change," she said.

A surveyor will now issue a requirement for improvement if he or she witnesses a healthcare worker fail to properly wash their hands before or after engaging with a patient. A requirement for improvement by the Joint Commission requires the organization to submit a plan detailing how they will resolve the issue. The commission follows up with the organization to ensure the correction plan has been implemented.

Brockway said surveyors have ample opportunity to witness clinicians interact directly with patients during the accreditation survey, which occurs every three years. Surveyors follow several patients throughout their care journey so they are in units and can observe patient care first-hand.

Healthcare workers' compliance with hand hygiene programs still remains a challenge. The CDC estimates that on average healthcare providers wash their hands less than half of the times they should.

A hectic workday is likely the main culprit of low compliance numbers, said Dr. John Lynch, medical director of the infection control, antibiotic stewardship and employee health programs at Harborview Medical Center in Seattle.

"Healthcare workers are busy," he said. "Even in the perfect world with great healthcare workers, hand hygiene gets missed."

It is also a task that can easily get redundant. For nurses and technicians who have significant direct patient contact, they are required to wash their hands hundreds of times a day.

Buy-in from key leadership can motivate more employees to comply with hand hygiene guidelines, Lynch said. "We know that if the senior physician doesn't wash his or her hands, the resident isn't going to do it," he said.

And it appears the Joint Commission change has gotten leaders' attention. Chris Hermann, president and CEO of hand hygiene technology company Clean Hands Safe Hands, said he has heard from about 150 health systems in the last three weeks who have asked to know more about the new requirement.

The Joint Commission change also supports a workplace where hand hygiene is openly discussed among employees, Lynch said. "You really need to have a culture where everyone plays a role — the person cleaning the room can call out the attending surgeon (for not washing his or her hands), the fellow can call out the technician, and not respond to it in an offensive way," Lynch said. "In my own experience, people become less sensitive to being called out, and I think the Joint Commission change reflects that."