Hand Washing Program That Reduced HAIs by 80 Percent
One in 25 patients will battle at least one infection picked up in the hospital, according to new data from the Centers for Disease Control and Prevention. In 2011, there were approximately 722,000 health care-associated infections nationwide and about 75,000 patients died. Still, hospital workers wash their hands only about 40 to 50 percent of the time, often because it’s inconvenient or they are overwhelmed by other tasks. Yet washing hands is one of the single most effective ways to prevent the spread of dangerous infections — ranging from pneumonia to MRSA, a life-threatening staph infection — in U.S. hospitals.
Anybody trained in medicine — any school kid, for that matter — knows that washing hands helps stop the spread of germs. But knowing doesn’t always translate into doing. Convenience is a big barrier: If sinks or antiseptic foam and gel dispensers aren’t readily accessible to medical staff, hand washing is easy to overlook in the midst of other responsibilities.
In an effort to improve hand washing and reduce HAIs, the experts at Vanderbilt University Medical Center (VUMC) implemented a clean hands initiative in 2009. Since that time, hand washing rates have jumped from 58 percent to 97 percent; at the same time, the number of infections has dropped, one of them by as much as 80 percent.
According to news reports, the program included installing additional hand sanitizer dispensers at the entrance and exit of every patient’s room or bay and within easy reach inside. Staffers were instructed to clean their hands before and after every encounter with patients, even if all they planned to do was have a conversation. Even the smallest details were addressed. Clinicians who complained that their skin had become irritated by excess antiseptic gel were told to cut back to a dime-size portion, and moisturizing lotion dispensers were added throughout the hospital.
Beyond the implementation of soaps and sanitizers, program officials also ramped up staff training, communication and overall education on transmission of germs and the direct link between hand washing and preventive infections. Each department committed at least one staff member as an “observer,” who monitored and documented hand washing 20 times per month. Performance was monitored to see how individual units and departments fared against each other and against a target goal set for VUMC, which was steadily bumped up year to year.
According to the reports, it took several months to resolve logistical questions about how observations would work. Experts understand that this is a process and people will have questions, some will be resistant to change, but in the end, it will all be worth it.
The CDC and the World Health Organization provide guidelines for good hand hygiene, but there is no one-size-fits-all approach to changing bad habits. Some hospitals rely on training sessions and educational posters. Others are turning to high-tech solutions, including electronic badges or bracelets worn by hospital workers, which automatically track compliance. One badge turns green when it detects hand sanitizer on a provider’s hands. Another communicates with sensors on foam dispensers and vibrates to remind staffers that they need to wash up.
Technology frees up human resources, works faster and reduces the likelihood that a practitioner will wash his hands only when he’s being watched. From the start, however, Vanderbilt focused on a communal approach: peer-to-peer communication. A mobile app designed in-house, which allows observers to record their findings on an iPhone or iPad, has made data collection quicker and less obtrusive than pen and paper. But that’s as high-tech as Vanderbilt has taken it.
Today, after more than 200,000 hand-washing observations, Vanderbilt’s overall hand-washing compliance rate has almost doubled. At the same time, three major types of infections linked to the insertion of tubes and catheters have been reduced considerably. Urinary tract infections related to catheters in intensive care units have dropped by 33 percent; pneumonia linked to ventilators by 61 percent; and bloodstream infections associated with central lines — the tubing that delivers fluids and medications to patients — by 80 percent in ICUs.
To read this full report, specific stats and complete details on the program, click here.