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Insights
Research
/ Literature
 AJMQ:
National study of hand hygiene compliance in the
USA,
tracking over 300 hospitals for twelve months.
more...
 JHI:
Thorough review of current hand hygiene monitoring and
feedback methods in USA. more...
 AJN:
Current challenges to
assess barriers, measure compliance, educate staff, and hold
staff accountable. more...
more...
Presentations
/
Abstracts
 SHEA:
4-Step Hand Hygiene Compliance and Accountability Model, a
multimodal strategy for improvement
more...
 IDSA:
A 6-year multicenter study of hand hygiene product usage
trends (soap vs. sanitizer) in the USA. more...
 APIC:
A continuing education presentation on a multimodal hand
hygiene compliance program.
more...
more...
Best Practices
Joint Commission
monograph
for hand hygiene adherence. 37 programs
reviewed including 4 using MMI program.
more...
 ICT:
May 2009 issue
of Infection Control Today reviews
several pertinent hand hygiene programs and practices.
more...
 Materials
in HC:
Hand Hygiene focus yields visible results, MMI program
supports multimodal HH plan.
more...
 Advisory
Board: "The Journey to
Zero" program aimed at key hospital leaders; makes a
case for IC programs
more...
more...
Media:
 MSNBC.COM:
"Hey, doc, wash your hands!" Patients
shouldn't be shy about asking providers to hit the sink,
experts say. Take the online survey and see what other
readers think!
Open new window...
Advising:
McGuckin Methods International counsels hospital teams,
healthcare organizations, professional associations, and corporate
healthcare partners.
more...
Events:
Word-OUT! Awareness Foundation's National Clean Hands Week.
Where else can you find
hospital officials,
celebrity healthcare advocates, a hand hygiene musical cast
of dozens, and Elmo all on one collaborative stage?
more...
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Hand Hygiene Literature
Review
There are many excellent articles that
have recently been published on hand hygiene. We review a
short list of various print and online resources to get introduce
you to issues we are facing this year. This is not by any
means a comprehensive list nor is it a "best of" bibliography.
You are encouraged to explore these issues and as you discover more
valuable references you wish to share with the infection control
community, please
E-mail us with your suggestions.
2010
Review
Coming soon
2009
Review
1. Compliance with Hand Hygiene Guidelines:
Where are we in 2008?
2. Hand hygiene compliance monitoring:
current perspectives from the USA
3. Joint Commission Standards - Frequently
Asked Questions from the Comprehensive Accreditation Manual for
Hospitals (CAMH)
4. The Joint
Commission Perspectives on Patient Safety
5. Hand Hygiene: It's All About When and
How
6. Attitudes of Healthcare Workers and
Patients Toward Individualized Hand Hygiene Reminders
7. Hand Hygiene Compliance Rates in U.S. – A
One-Year Multicenter Collaborative Using Product/Volume Usage
Measurement and Feedback
2008
Review
1. Measurement of Compliance with Hand
Hygiene
2.
Healthcare-Associated Infections - Strengthening the Patients'
Health
3. Statewide Partnership and CEO
Challenge to increase and Sustain Hand Hygiene Compliance
4. The effect of random voice hand hygiene
messages delivered by medical, nursing, and infection control staff
on hand hygiene compliance in intensive care
5. HAIs, “Meeting the Challenge”
6. How much time is needed for hand
hygiene in intensive care? A prospective trained observer
study of rates of contact between healthcare workers and
intensive care patients.
1. Haas, Janet P. DNSc, RN, CIC;
Larson, Elaine L. PhD, RN, CIC, FAAN. Compliance with Hand
Hygiene Guidelines: Where are we in 2008? American Journal of
Nursing. 108(8): 40-44, August 2008.
The authors argue that hospitals may
best improve compliance by assessing the barriers to it, measuring
the rates of compliance, education staff on the importance of hand
hygiene, making sanitizing products more available for staff use,
and holding staff accountable. The authors emphasize as well
that lasting improvement in hand hygiene is a collaborative effort
that depends on the committed support of hospital administrators.
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2. Boyce, John M. Hand hygiene
compliance monitoring: current perspectives from the USA. Journal of
Hospital Infection (2008) 70(S1) 2-7.
Monitoring hand hygiene compliance and
providing healthcare workers with feedback regarding their
performance are considered integral parts of a successful hand
hygiene promotion program. Direct observation of care providers by
trained personnel is currently considered the gold standard.
Advantages include the ability to determine if hand hygiene is being
performed at the correct times, establish compliance rates by
healthcare worker type, and assess hand hygiene technique. However,
observation surveys are time-consuming, permit observation of only a
small fraction of all hand hygiene opportunities, and can be
influenced by inter-rater reliability. Comparison of compliance
rates obtained through observation surveys is problematic due to
lack of standardization of criteria for compliance and observation
techniques. Self-reporting of compliance is not sufficiently
reliable to be useful. Monitoring the usage of hand hygiene products
requires much less time and can be performed on an ongoing basis,
and is less complicated. However, it does not provide information
about the appropriateness and quality of hand hygiene practices or
compliance rates by health-care worker type. Furthermore, it is not
clear how product usage correlates with compliance established by
observational surveys. Electronic methods for monitoring compliance
require further evaluation before they can be routinely recommended.
Clearly, further research is needed to develop efficient, reliable,
and reproducible methods for monitoring hand hygiene compliance.
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3. Joint Commission Standards -
Frequently Asked Questions from the Comprehensive Accreditation
Manual for Hospitals (CAMH)
NPSG 07.01.01 Q&A
Follow this link to get the answers to the following questions.
(Opens new window)
Q. Where can I find the current Center
for Disease Control and Prevention (CDC) hand hygiene and World
Health Organization (WHO) guidelines?
Q. Does Joint Commission require implementation of all the
recommendations in the CDC or WHO hand hygiene guidelines?
Q. The CDC guidelines say that health care personnel should not wear
artificial nails and should keep natural nails less than one quarter
inch long if they care for patients at high risk of acquiring
infections (e.g. patients in intensive care units or in transplant
units). The WHO guidelines prohibit artificial nails and extenders
for all healthcare workers. Will Joint Commission actually be
requiring this?
Q. Do we have to use alcohol-based hand products?
Q. What are the “conditions” that have to be met to be able to
install alcohol-based hand rub (ABHR) dispensers in egress
corridors?
Q. Is there an expectation for individuals passing patient trays at
mealtime to use alcohol-based hand rub between each room?
Q. The CDC and WHO guidelines contain several options for
measurement of hand hygiene compliance. What method would be
considered acceptable by JCAHO under NPSG.07.01.01?
Q. May we “pick and choose” some recommendations from CDC and some
from WHO, or must we decide to follow one of the guidelines in its
entirety?
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4. The Joint
Commission Perspectives on Patient Safety, September 2008, 8(9)
10-11.
Communication with patients and families
about all aspects of their care, treatment, or services is an
important characteristic of patient safety. When patients know what
to expect, they are more aware that the choices they make can affect
their care, and they are more likely to catch potential errors.
The Joint Commission's National Patient Safety Goal 13.01.01 01
requires that organizations define and communicate the means for
patients and their families to report concerns about safety and
encourage them to do so.
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Follow this link for full excerpt.
(Opens new window)
5. Pittet, Didier MD, MS. Hand
Hygiene: It's All About When and How. Infection Control and Hospital
Epidemiology. October 2008, 29(10) 957-9.
An excellent editorial on two components
of hand hygiene, the When and How. Pittet
ends his editorials with these words " the time has come to teach,
request, monitor, and provide feedback to staff on both the how and
when to cleans hands to achieve a continuous, sustained, and
universal improvement to patent safety."
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6. Julian, Kathleen G. MD,
Subramanian, Kavitha MD, Brumbach, Arlene MS, CIC, Whitener, Cynthia
J. MD, Attitudes of Healthcare Workers and Patients Toward
Individualized Hand Hygiene Reminders. Infect Control Hosp Epidemiol.
2008 Aug;29(8):781-2.
Letter to the editor. The authors
suggest that encouraging patients to ask about hand hygiene needs to
go beyond posters. They also report results of HCW survey showing
they were okay
with patients asking them to wash.
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7. McGuckin M, Waterman R,
Govednik J. Hand Hygiene Compliance Rates in U.S. – A One-Year
Multicenter Collaborative Using Product/Volume Usage Measurement and
Feedback. Am J Med Qual. 24 (3) 205-213. DOI:
10.1177/1062860609332369.
Hand hygiene (HH) is the single most important factor in the
prevention of healthcare acquired infections (HAIs). The three most
frequently reported methods of measuring HH compliance are (1)
direct observation, (2) self-reporting by healthcare workers (HCWs),
and (3) indirect calculation based on HH product usage. This paper
presents the results of a 12 month multicenter collaboration
assessing HH compliance rates at healthcare facilities in the U.S.
by measuring and providing feedback for HH compliance. Our results
show that HH compliance at baseline is 26% for Intensive Care Units
(ICUs), and 36% for non-ICUs. After 12 months of measuring product
usage and providing feedback, compliance increased to 37% for ICUs
and 51% for non-ICUs. (ICU p=0.0119, NON-ICU p < 0.001). HH
compliance in the U.S. can increase when monitoring is combined with
feedback. However, HH still occurs at or below 50% for compliance
for both ICUs and non-ICUs.
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1. Haas,
J.P. and Larson, E.L. Measurement of Compliance with Hand Hygiene.
Journal of Hospital Infection (2007) 66. 6-14.
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An
extensive review of the literature on hand hygiene measurement
resulting in 662 articles of which only 34 described the method in
detail. Excellent source for ICPs trying to decide on a
compliance program. www.hhreports.com/downloads/PSLUSeptemberstandard.pdf
(Opens new window)
2.
Healthcare-Associated Infections - Strengthening the Patients'
Health, Report (2006) of Chief Medical Office for England and the
United Kingdom (Sir Liam Donaldson).
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Excellent
perspective on patients' role. See web site:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_076817
(Opens new window)
3. Society for Healthcare Epidemiology of
America (SHEA) Annual; Meeting, Baltimore April 2007, oral abstract
McGuckin M,Wagner C ,Shubin A, Waterman R, Statewide
Partnership and CEO Challenge to increase and Sustain Hand
Hygiene Compliance.
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The authors reported on the implementation of a statewide
intervention Partners in Your Care and measurement program as
well as a challenge by CEO's for the best hand hygiene compliance
rate. They reported a 24% increase in compliance for non-ICU
and 74% increase for ICU. Their model addresses the Theory of
Planned Behavior in which expectations of important people results
in social pressure to please.
4. Amer J Inf Control, Dec 2006;Vol 34(10):673-675 McGuckin M, Shubin A, McBride P, Lane S, Strauss K, Butler
D, Pitman A. The effect of random voice hand hygiene
messages delivered by medical, nursing, and infection
control staff on hand hygiene compliance in intensive care.
Return to Top
Abstract: http://www.ajicjournal.org/article/PIIS0196655306002082/abstract
(Opens new window)
5. AJMQ,
Supplement to Vol 21, No. 6, Nov/Dec 2006
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The Nov/Dec issue of AJMQ contained a supplement on HAIs,
“Meeting the Challenge”. The data used in each of the
articles is the data from PHC4 (Pennsylvania Health Care
Cost Containment Council). As you may know, Pennsylvania in
July 2005 became the first state to publicly report
statistical data on HAIs.
http://www.phc4.org.
This supplement I am sure will be met with the same
criticism, doubt and debate as the PHC4 data has been over
the past (2) years. However, we need to move forward and
maybe this is an early wake-up call to get back to the
basics of patient care practices.
6. Journal of Hospital Infection (2006)62,304-310. McArdle, F.I. et al, How much time is needed for hand
hygiene in intensive care? A prospective trained observer
study of rates of contact between healthcare workers and
intensive care patients.
Return to Top
In summary, these authors bring further support to our
rationale of using 144 HH/bed day as 100% compliance for
ICU. They found the number of direct contact to be 159 per
day (95% CI). Excellent well designed article. |
