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H&HN Daily

It's Simple: Wash Your Hands

12.03.12 by Matthew Weinstock H&HN Assistant Managing Editor

Utilizing video cameras, one ICU unit sees a seismic jump in hand hygiene compliance.

Do you remember that old Bill Cosby show, "Kids Say the Darndest Things" (I'm not old enough to recall Art Linkletter's "House Party")? It was great; kids speaking the truth, a lot of times saying exactly what we grownups were thinking but, for a variety of reasons, chose to self-censor.

Well, I was struggling to write this blog late Sunday (the day-long headache wasn't helping, nor was the memory of Da Bears late-game meltdown), so I played the part of Cosby and turned to my seven-year-old twins for inspiration.

"What would you say to a doctor or nurse who didn't wash their hands before they came to see you?" I asked.

My daughter: "Are you kidding me? Wash your hands. Don't you know that you could get sick, or get me sick? Sheesh."

My son, loading his new six-shooter Nerf gun, exclaimed: "You're a doctor! You are supposed to wash your hands!" (Don't mess with the kid, he's a sure shot.)

And with that, I bid you all a happy National Handwashing Awareness Week. Now, I don't profess to know much about the origins of this holy week. Heck, I'm constantly being barraged by messages asking if we'll cover everything from National Sleep Awareness Week to National Gastroesophageal Reflux Disease Awareness Week or American Diabetes Month. Who knew that there were so many things to pay attention to during the course of a year? However, a pitch built around National Handwashing Awareness Week did catch my eye: an East Coast hospital increased hand hygiene compliance in its ICU from less than 10 percent to more than 80 percent in roughly four weeks. The unit has sustained those scores for more than two-and-a-half years.

The pitch, as most do these days, came from a technology vendor's PR firm. What's interesting though is the technology wasn't necessarily the driving force behind the improvement; it was just on piece of the puzzle.

North Shore University Hospital in Manhasset, N.Y., in 2008 adopted technology that's been used for everything from monitoring sanitation in meat processing plants to encouraging drivers to stop at red lights and obey the speed limit — video cameras. Donna Armellino, vice president, infection prevention for North Shore-LIJ Health System, says that the hospital had historically relied on "the gold standard" for hand hygiene compliance — human observation. But when the hospital received a patient safety grant from the state health department, official began to explore new ways to improving hand hygiene.

Twenty-one cameras were installed in the hospital's 17-bed ICU, to the tune of $50,000. The cameras had views only of sinks and hand sanitizer dispensers. North Shore officials and its contractor, Arrowsight Inc., crafted a series of guidelines and measures to study. For instance, the definition of a "passing" hand hygiene event: the health care worker "remained in a patient room for 60 seconds or more and performed hand hygiene at the entrance or inside the room, or inside or outside an adjacent room within 10 seconds before or after entering or exiting a patient room."

Clinicians were all informed about the video monitoring. Interestingly, when the cameras first started rolling, hand hygiene rates failed to really pick up, says Adam Aronson, CEO of Arrowsight. It wasn't until data started coming back to the unit and a feedback loop was in place that rates changed. Large LED monitors were placed throughout the unit and displayed real-time hand hygiene compliance rates, accompanied by phrases like "Great Shift!" and "Keep it up!" The monitors were in public view, so even patients and family members could see them. Armellino says that the unit's rates now hover around 85 percent and they are continually striving to get it higher.

Results of the project were published in Clinical Infectious Disease last year. And it got some press coverage in the New York Times and other NY media outlets. Still, it was interesting hearing Aronson and Armellino talk about human behavior and explain how the technology alone is not the solution.

For so many reasons, hand hygiene is one of the most vexing problems in health care. The Joint Commission in 2004 named it a National Patient Safety Goal. More recently, it was one of the first issues tackled by the commissions Center for Transforming Healthcare. The commission has even published a monograph on the issue.

As my kids pointed out, it should be a no-brainer, but it seems like a constant battle. We've profiled numerous organizations that have put in programs to improve compliance rates, everything from offering financial incentives to utilizing secret shoppers or deploying various technologies. But as the North Shore experience suggests, the key is creating a constant loop of feedback and learning.

I'll admit, it is easy make light of something like National Handwashing Awareness Week. What's not funny though is the risk posed to countless patients because health care workers fail to follow proper protocols. And with severe payment penalties now tied to HAIs, maybe every week should be deemed National Handwashing Week.

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