Abstract or Overview

Additional Information

A national study of hand hygiene compliance improvement using MMI's Hand Hygiene Reports

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. 

• Compliance can improve with the MMI monitoring program.  More info on the hospitals page.

• Monitoring must be combined with feedback

• Contact Dr. Maryanne McGuckin, lead author, at mcguckin@hhreports.com

• Full article available at Sage Publications:  http://ajm.sagepub.com/cgi/content/abstract/24/3/205

A Comparison of Observation, Self-Reporting, Product Usage, and Electronic Devices. 

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.

• Every method of hand hygiene compliance has strengths and weaknesses.

• We at always recommend using two methods when monitoring so that one's strengths make up for the other's weaknesses.

• MMI's program is featured in the product usage segment:

  Another method that is utilized by numerous facilities involves recording the amount (ml) of soap used on each nursing unit per bed-day.... Data can be submitted electronically to a central Internet-based data analysis center (www.hhreports.com), which provides each facility with time-trend data and a comparison with comparable nursing units in facilities of similar size. Advantages of this approach include that fact that such measurements are relatively easy to conduct and are feasible in a variety of healthcare settings.

• One source you can obtain a copy of this article is from: http://linkinghub.elsevier.com/retrieve/pii/S0195670108600031

Assess Barriers, Measure Rates, Educate Staff, Make Products Available, and Hold Staff Accountable

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.

It has long been known that hand hygiene among health care workers plays a central role in preventing the transmission of infectious agents. But despite a Joint Commission requirement that Centers for Disease Control and Prevention hand hygiene guidelines be implemented in hospitals, compliance among health care workers remains low. The authors argue that hospitals may best improve compliance by assessing the barriers to it, measuring the rates of compliance, educating 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.

• Review of the barriers including detailing McGuckin study providing possible solutions

• Affirmation of a multimodal strategy

• Article source can be found at this link

WHO Guidelines for Hand Hygiene

On May 5, 2009 WHO Guidelines on Hand Hygiene in Health Care as part of the First Global Patient Safety Challenge Clean Care is Safer Care was released. This process began in 2005 with the development and testing of the document in 8 pilot sites as well as 300 additional test sites, and followed by the development and testing of tools for hand hygiene. Soon the project received support from ministers of health. Finally the global awareness of HAIs and the need for multimodal behavior change strategies to increase HH compliance is here!  The guidelines represent a comprehensive document that has been field tested and include implementation and evaluation tools.

• Developed with assistance from over 100 renowned international experts.

• Adopting the guidelines will contribute to greater awareness and understanding of the importance of hand hygiene.

• Tested and given trials in modern, high-tech hospitals in developed countries as well as remote clinics in resource-poor villages.

• Dr. McGuckin is lead author for Ch.5, Patient Involvement in Hand Hygiene Promotion.

• All materials are free and available for download at http://www.who.int/gpsc/en/ 

Abstract or Overview

Additional Information

SHEA POSTER ABSTRACT:  A Four-Step Hand Hygiene Compliance and Accountability Model     Lynne Karanfil RN, MA, CIC, Kathy Finch, RN, BSN, CIC, Brenda Knox, John Govednik, MS, Maryanne McGuckin, Dr. ScEd

• Four step program includes: (1) Baseline observation and goals, (2) accountability tools for training and feedback, (3) patient empowerment, and (4) measurement and feedback.

• Good Samaritan Hospital of Baltimore, MD (Medstar) was given goal of 90% hand hygiene (HH) compliance by administration.  Observation results reached ~90% almost immediately. 

• A secondary, surrogate method of monitoring was brought in to cross-check the observation.  They used MMI's product volume measurement program. more info...

• In two non-icus shown as example (left), the observation compliance rates (blue) are compared to product volume measurement rates (teal).  Note observation compliance was consistently high while product usage monitoring started low and took several months of consistent monitoring and feedback before reaching similar levels of compliance.

• Purple vertical dotted line indicates when system of feedback (monthly reports) was implemented.  Observation dipped while product usage soared upward.  This suggests observers were made more aware of unintended bias and scores for observation may reflect more stringency.  The increase in product usage attributed to feedback that HCWs were not performing HH as often as should.

• Magenta vertical dotted line indicates when Ecolab's educational program "It's OK to Ask" implemented, healthcare workers invited patients to remind HH. Product usage continued to increase.

• Conclusion:  A multimodal HH monitoring program will address more areas of compliance than observation alone.

• Contact Kathleen Finch, RN, BSN, CIC, Good Samaritan Hospital, Kathy.Finch@Medstar.net, or Lynne Karanfil, RN, MA, CIC, Medstar Health – Performance Improvement, Lynne.V.Karanfil@Medstar.net

• A PowerPoint PDF on this program appears on the Maryland Hospital Hand Hygiene Collaborative website.

IDSA POSTER ABSTRACT:  Hand Sanitizer Compliance in the USA:  A Six-Year Multicenter Trend Analysis

John Govednik, Richard Waterman, Maryanne McGuckin

• We analyzed six years of data from MMI's National Hand Hygiene Database, where hundreds of hospitals track their compliance using product usage methodology.

• Of all the HH events performed in 2004, 46% used sanitizer in the ICU and 46% also in the non-ICU used sanitizer.  This means that less than half the HH performed by HCWs in 2004 used sanitizer.

• Jump ahead to 2008, of all the HH performed, in the ICU, 42% used sanitizer, and in the non-ICUs, 38% used sanitizer.  This means that the choice of sanitizer dropped, and HCWs are choosing soap more than sanitizer for their HH.

• In the first quarter of 2009, ICUs used sanitizer 38% of all HH, while in the non-ICUs, sanitizer was used 32% of all HH.  So we continue to use sanitizer less and less over time.

• We will be updating this study to cover the 09-10 flu season.

• Conclusion:  despite recommendations from WHO and CDC to use sanitizer for hand hygienes unless hands are visibly dirty, we use less now than before the recommendations were made.

• This study is conducted in patient care areas only and does not include results impacted by the great efforts to provide products and education at entrances and lobbies, for visitors to use.

• Contact John Govednik, MS at govednik@hhreports.com for info.

APIC CONTINUING EDUCATION: A Multimodal Hand Hygiene Compliance Program

John Govednik, MS (MMI) and Gwen Stewart, RN, BSN (Sibley Hospital of Washington, DC).

• Components of a multimodal plan:

  •   The right hand hygiene products, comfort and access

  •   Healthcare worker education and training on proper use

  •   Patient education - patient empowerment more...

  •   Measurement - observation for quality, product use for quantity more...

  •   Feedback - consistent monthly feedback on compliance

• Sibley Hospital of Washington DC shared their implementation of a multimodal plan including observation, MMI's product usage program, and many examples of patient and healthcare worker education.

• Contact John Govednik, MS at govednik@hhreports.com for measurement or general questions on the presentation

• Contact Gwen Stewart, RN, BSN at gstewart@sibley.org for more information on the program at Sibley

• This program was hosted by Ecolab, provider of the Hand Hygiene Compliance Program "It's OK to ASK" featuring MMI's measurement methodology and reviewed in Joint Commission Monograph on Hand Hygiene.  See Joint Commission monograph for more. (new window)