Today’s leaders of healthcare facilities are faced with the difficult challenge of convincing patients that it’s safe to return to critical and elective care. Patients are seeking assurances that their healthcare provider has made their personal well-being a priority from the moment they enter the facility. Hand hygiene is a critical part of patient safety and it is important for healthcare leaders to understand the central role it plays. It is one of the most foundational aspects of patient safety that spans across all hierarchies and disciplines, and there is much room for improvement in virtually every healthcare organization.
Both the Leapfrog Group and The Joint Commission (TJC) have stated indications for 2021 that aim to advance and increase the amount of hand hygiene performed in healthcare settings. Organizations that want to prosper must demonstrate improvement by monitoring hand hygiene, setting goals for improvement and demonstrating progress. Aligning organizational goals around hand hygiene is a critical part of a winning strategy.
What makes hand hygiene so challenging? First, hand hygiene is a simple task performed in a complex environment. Second, hand hygiene is challenging because it is the task performed the most in any healthcare setting. Automated hand hygiene monitoring systems have shed new light on this.1 No other task comes close and involves so many healthcare workers.
The first step in a successful hand hygiene improvement plan is to secure top-to-bottom alignment around common goals. Frontline staffers need to understand how any upcoming changes will affect their day-to day lives and why hand hygiene is a priority for the organization. Managers must be prepared to explain the details and allocate resources as needed. Without education and commitment at all levels of the organization, hand hygiene initiatives are likely to founder amid competing priorities.
Due to the industry’s ongoing reliance on direct observation as the primary method of measuring hand hygiene, the next step for many hospitals is to implement a more accurate, efficient, and reliable measurement system. This can involve using mobile applications to make direct observation more efficient, or a more robust electronic monitoring system (EMS).
Electronic Monitoring offers several key advantages over direct observation including 24/7 monitoring producing a much larger data set, covering every shift. This allows leadership to identify high-performing units and those that are struggling, facilitating the design of targeted interventions. EMS also provides objective data, eliminating human biases and error. Less labor is required for observation and reporting, leaving infection preventionists with more time to devote to training, coaching, and other activities that directly improve clinical quality.
Once hospital leaders are able to develop an accurate baseline measure of hand hygiene compliance and track changes over time, they can start setting goals for improvement. It is critical to focus on achieving sustainable improvement by setting a series of small, realistic goals that can be met over time. At each step, leadership can examine the results of the latest phase of improvement, identify best practices and residual obstacles, compare success rates for different types of interventions, and design a more targeted plan for the next phase.
Leadership needs to continually emphasize that hand hygiene is a priority and provide reinforcement to frontline staff. There can be significant benefits to even relatively low-key activities such as having executives tour a high-compliance unit to understand how its members approach hand hygiene. Not only will the visit encourage the staff, but it will also give decision makers a ground-level view of the challenges they are facing.
At a more granular level, supervisors and infection preventionists should be empowered to provide feedback and coaching to nurses, doctors, and other personnel. Implementing an electronic monitoring system can help by freeing up time and providing objective data for performance evaluations.
It’s critical for all parties to remember that improving hand hygiene isn’t a short-term, one-time project; it’s an ongoing campaign. As compliance rates improve, the challenges will not disappear—they will evolve. Hospital leaders need to be prepared to support a long-term effort that requires substantial investments of time, energy, and money to be successful.
