ike Sullivan, managing director of hand hygiene products Industries – Europe writes his latest hand hygiene blog for the ECJ website. He has worked closely with the UK National Health Service (NHS), the World Health Organisation (WHO), the Société Française d’Hygiène Hospitalière, the Infection Prevention Society, the Association for Prevention in Infection Control, and Private Organisations for Patient Safety (POPS).
“One of the great mistakes is to judge policies and programmes by their intentions rather than their results.” This quote is attributed to the late Milton Friedman, an American economist, statistician and writer who, in 1976, received the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel ‘for his achievements in the fields of consumption analysis, monetary history and theory and for his demonstration of the complexity of stabilization policy’.
When he spoke those words, he was no doubt thinking about the complexities of financial markets, but their main premise can be applied to many areas of work and life – hand hygiene compliance being one of them.
The importance of good hand hygiene and its positive impact on patient outcomes and safety cannot be underestimated, and has been an accepted fact for many years. When it comes to healthcare, the intention – to reduce the incidence of healthcare-associated infections (HCAIs) – can certainly be achieved by improving the results – i.e. increasing levels of hand hygiene compliance among healthcare workers.
Several studies have demonstrated an association between a reduction in HCAIs and increased hand hygiene compliance rates (1)(2), so evaluation is already playing a crucial role. However, the debate about how best to monitor hand hygiene compliance levels – put simply, how often healthcare workers, nurses and medical staff wash their hands – is beginning to gain some real momentum.
Direct observation has traditionally been the most popular way for hand hygiene compliance to be measured, and there is still a place for this. However, as in so many other walks of life, technology is now helping to shape mechanised alternatives that aim to improve processes and capture data automatically.
My colleagues in the US recently presented a scientific research study at the Association for Professionals in Infection Control and Epidemiology (APIC) annual meeting in Florida, entitled ‘Impact of Electronic Monitoring and a Hand Hygiene Environment Programme on Compliance Rates’. Led by Sarah Edmonds MS, the research was conducted on two units of an acute-care facility in Fort Worth, Texas, from June 2012 to October 2012. Edmonds said: “We were able to measure a significant increase in hand hygiene compliance over baseline during the intervention period, and also observed a sustained improvement in compliance for approximately two months post-intervention.”
This is undoubtedly encouraging, and merits further close engagement with infection control nurses to help shape the compliance technology solutions that will work best for them. Some facilities may welcome systems that simply count each time a dispenser dispenses soap or sanitiser. However, for others, more complex solutions concentrating on the behaviour of identified individual care givers may be more appropriate.
Unlike VHS’s triumph over Betamax, I believe that no clear ‘winner’ will emerge. The smartest systems and solutions will be the ones that adapt to individual circumstances, and to the inevitable changes in regulation and assessment criteria that will come in the future.
Technology alone cannot effect a sustained change in hand hygiene compliance rates, but the data it can provide will help by informing the other interventions and actions that can also drive improvements. This includes how we communicate the importance of good hand hygiene to healthcare workers, members of the public, and patients themselves; and how training programmes can be enhanced and made more relevant. It could also have a galvanising effect on research and development, inspiring the creation of ever more effective formulations and dispensing systems.
Debates will continue over the coming years, but one thing is certain: the healthcare community has the avowed intention to reduce HCAIs through improving hand hygiene compliance – and we are working hard to ensure that the technology helps us to deliver better results – continually and consistently.