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Infection Control / Infection Control
February 2014 Cover Story

The Future Of Infection Control

Studies prove hand hygiene importance while monitoring technology improves program compliance.

January 31, 2014
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Infection control — though the concept sounds simple enough, it is actually a serious cleaning industry issue that includes a multitude of responsibilities.

Through cleaning and prevention, education and action, facility managers and building service contractors use sound infection control practices to prevent illness outbreaks and treat “sick buildings.”

From surface disinfection and sanitization to restroom cleaning and hand hygiene programs, there are many important links in the chain of effective facility infection control.

This is especially true in hospitals and the healthcare market.

Various scientific studies have proven the importance of hand hygiene in this arena, and new ideas and technology stand ready to improve practices and strengthen the chain of infection control.

Unhealthy Hospitals?

While most people think of hospitals and other healthcare facilities as places to receive treatment and regain strength, cleaning quality and safe infection control can have a large impact on patients’ overall wellbeing.

In fact, around 2 million patients acquire hospital-related infections every year, according to the U.S. Centers for Disease Control (CDC), and almost 100,000 die from these infections.

Recognizing hand hygiene’s contribution to a strong healthcare infection control program, one group set out to study and improve hand hygiene compliance in this market.

Klaus Nether is center solutions development director with the Joint Commission Center for Transforming Healthcare.

“The Center for Transforming Healthcare is an entity under the Joint Commission Enterprise,” Nether says. “It was created in 2008 to address some of healthcare’s safety and quality issues.”

The center works with participating organizations — hospitals and healthcare organizations — to address important issues, Nether notes, and hand hygiene was the first program that the participating organizations identified to address.

Studying The Issue

Using a scientific approach, the group:

  • Looks at what the issues are
  • Measures these issues to gauge their severity
  • Identifies contributing factors
  • Targets solutions specifically to these factors
  • Develops a control plan to sustain improvements over time.

Working with eight healthcare organizations across the United States, the commission developed a measurement system to monitor employee wash ins/wash outs in patient areas using the same parameters, Nether states.

A measurement system was created that used secret observers to collect data, and training modules taught them how to observe, how to fill out the forms and included a test for them to take.

According to Nether, employees who were expected to wash in/wash out at the facilities included laboratory workers, nutritionists, dieticians and environmental employees.

Using this system, baseline wash in/wash out compliance at the eight organizations was, as an aggregate, 47.5 percent, Nether explains.

Looking at the eight healthcare facility participants, different contributing factors were identified at each location.

Over 20 different hand hygiene contributing factors were found, including:

  • Inoperable or empty soap dispensers
  • Perception of excessive hand cleaning being required
  • Broken sinks
  • A lack of accountability
  • Distractions and forgetfulness
  • Issues with wearing gloves.

To address the specific issues at each location, targeted solutions were developed and a control plan was created to sustain hand hygiene improvements over time.

“One of the things that we learned is that best practices don’t always work,” Nether reveals. “Best practices were created to address specific contributing factors that were identified at that organization that developed those best practices. And sometimes, as you adopt those best practices, they may not work at your organization. Although we all had the similar problem with hand hygiene, the contributing factors were different from one organization to the next.”

Maintaining Improvement

According to Nether, the eight hospitals that started with an aggregate wash in/wash out compliance of 47.5 percent ended the study with an aggregate of 81 percent and sustained that performance for 11 months.

“There is a correlation with hand hygiene and health acquired infections, so one of the organizations that actually implemented the targeted solutions tool … they actually saw that as their hand hygiene compliance rates went up, their blood stream infections actually decreased by 66 percent,” Nether states.

While there is definitely a correlation between hand hygiene and infections, there are other factors that can affect the rate of health acquired infections (HAIs), Nether notes.

Using these findings, the commission created a Targeted Solutions Tool to help individual healthcare organizations decrease HAIs and increase hand hygiene compliance in approximately 12 weeks, according to Nether.

The next challenge is sustaining the improvement, Nether says.

To guarantee the hand hygiene program moving forward, organizations should continue measuring and develop a control plan to monitor the process.

If any dips are seen in the hygiene program measurements, an organization must react before it gets too bad, Nether concludes.

New Monitoring Technology

New technology has changed almost every facet of the cleaning industry, and now it stands ready to improve facility hand hygiene programs as well.

Jeff Hall, compliance program director, North America, with GOJO Industries Inc., says hand hygiene has become a subject of high importance in the cleaning and healthcare industries.

This is due to the huge impact that it can have on health and well-being — possibly even saving lives.

Hall notes it has been proven through multiple studies that hand hygiene is the number one way to prevent the spread of infection1 and that hand hygiene compliance rates in healthcare average less than 50 percent nationally.2

The bottom line is that HAIs are a chronic and costly problem that require quantitative data to demonstrate performance, Hall states.

That is the biggest reason newer electronic monitoring system technology is now necessary; it allows for measurement and accountability.

“In order to improve hand hygiene, we need to give hospitals the tools to measure it and the clinical education resources to interpret the data,” Hall explains. “One solution does not fit all hospitals; we work individually with each hospital to find a solution and technology that works for them.”

How It Works

Healthcare personnel function in an environment of heavy workloads, enormous responsibilities, multitasking and being constantly pressed to do more things in less time, according to Hall.

This challenges their time management, priority setting and efficiency of practice.

That is why Hall’s company was committed to providing hand hygiene solutions that make compliance easier.

Hand hygiene technology systems that became available earlier this year measure and improve hand hygiene compliance.

Hall states his type of technology can include:

  • An activity monitoring systemthat measures compliance on a community level providing real-time actionable data by floor, unit or room.
  • Technology that monitors and measures hand hygiene compliance at an individual level through Real-Time Locating System (RTLS)-enabled employee badges. (A system can integrate with existing third-party RTLS systems.)
  • In addition, some companies provide a representative or employee who becomes part of the hospital’s infection prevention team and provides customized implementation, on-site audits, setup, baseline measurements and detailed improvement plans
  • Finally, software can allow users to automatically upload, visualize and analyze data from a free application for portable devices used to electronically collect hand hygiene events.

Compliance Study

Hall’s company conducted an independent research study at the John Peter Smith Hospital in Fort Worth, Texas, to determine the impact on hand hygiene compliance rates when the hospital hand hygiene program included an electronic compliance activity monitoring system.

During the study, the system was installed to monitor all patient room entries and exits and all hand hygiene events from touch-free soap or hand sanitizer dispensers.

Compliance was measured as number of events in contrast to number of opportunities, and included the entire community, not only healthcare workers.

The study duration was three months during which a comprehensive hand hygiene program for healthcare workers, patient and visitors was implemented.

Additional education was established including the development of a hand hygiene improvement goal, leadership support and feedback opportunities for the staff.

Results of the study were presented at the APIC 2013 Conference.

The authors concluded that during the study period of June to September 2012, there was a 92 percent increase in hand hygiene compliance rates — from 16.5 percent at baseline to 31.7 percent — when an electronic monitoring system was included in a hand hygiene program.

During the post-study period the rate decreased to 25.8 percent, still significantly above baseline.

Through the study, it was found that the implementation of an electronic hand hygiene compliance monitoring system as part of a clinical hand hygiene program can significantly increase hand hygiene compliance.

“We also are aware that additional data is needed to better understand the impact of electronic compliance monitoring programs on clinical outcomes, such as infection rates,” Hall says.

Today, it is clear that safer facilities equal improved employee production, increased profitability and healthier communities.

Thankfully facility managers, service contractors and workers are not fighting this important battle alone.

New technologies, scientific studies and updated approaches offer the promise of safer, cleaner and healthier facilities in the future.


1 According to the CDC, “Hand Hygiene Project: Best Practices for Hospitals …” Joint Commission, Nov. 2010.
2 Herbert C. Weber SG. Common approaches to the control of multidrug-resistant organisms other than methicillin-resistant Staphylococcus aureus Mar:25(1): 181-200. Epub 2010 Dec. 17.

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