By Theis Jensen, CEO, Sani nudge
Multidrug-resistant organisms are increasing worldwide and is currently one of the most important challenges that we are facing in cross-border healthcare. The prevention of spread in health-care settings and across borders are urgent because of the limited number of antibiotics available to treat these infections .
The spread of the healthcare- acquired infections occurs predominantly via healthcare workers’ contaminated hands which is well-known to most infection preventionists. In the day to day life, the simple act of washing hands or performing alcohol-based hand sanitization can reduce the number of infections dramatically. Yet, studies show that healthcare workers’ hand hygiene in most hospitals all over the world is disturbingly poor .
Methods to improve hand hygiene compliance have not fundamentally changed in over a century but is now about to change. I will in this article walk you through the top five emerging hand hygiene trends that you should be aware of.
1- Direct Observation is so 2018. A good first step to improve hand hygiene is getting real with audit data. In healthcare settings, direct observation of hand hygiene by a secret shopper is currently the most used method globally. However, most infection preventionists know that the method provides very questionable data due to human biases such as the Hawthorne Effect. Studies have shown that healthcare providers know when they are being watched by the secret shopper and are therefore three times more likely to clean their hands than when not being observed . Unfortunately, this gives an untrue picture of the hygiene situation. In addition, the method only monitors hygiene performance and does not improve the healthcare workers hygiene behavior.
Many hospitals continue to submit the misleading data showing hand hygiene performance rates above 95% while their healthcare-associated infection rates keep increasing. Many of these hospitals are even on the HAC (Hospital- Acquired Conditions) list which seems contradictory when they report hygiene performance rates at nearly 100%. Partially due to an increased pressure from the Joint Commission , hospitals are now quitting the use of direct observations of healthcare workers’ hand hygiene performance and are looking to find new, validated and robust methods. The leading hospitals will in 2019 face the fact that data generated by direct observations is seriously flawed and will get management support to fix it.
2- Penalty as a motivator. Last year, the Joint Commission intensified the pressure for hospitals to improve hand hygiene by introducing new guidelines. In line with their notice, inspectors started to issue citations to hospitals after observing cases with only few failed hand hygiene opportunities. This can lead to inspector revisits and even put the hospital’s accreditation at risk. Therefore, hospitals will be more serious about making significant improvements in hand hygiene performance in 2019.
- 3. Actionable Data as a standard. Food manufactures, airports and shopping malls are just some of the industries that have been using Internet of Things (IoT) and big data to revolutionize their business and now IoT is beginning to transform the healthcare sector as well. IoT sensors and other technologies can capture hand hygiene performance in real-time, on a continual 24-hour basis and without bias – unlike direct observation. The data can be analyzed in new and exciting ways, with cutting edge visualization that makes it possible for healthcare managers to identify how they most efficiently change hand hygiene behavior in their facility. Many electronic hygiene technologies integrate with electronic medical record systems to automatically sync patient condition with hand hygiene protocols. The combination of data can be used to identify the patients at highest risk of contracting a healthcare-acquired infection and enables the physicians to intervene before the infection actually occurs. This opens up for the area of predictive analytics which we will see more of in the near future
- 4. Lower Costs. Automated monitoring of hand hygiene compliance is a promising new innovation, but the automated monitoring systems have been very expensive for hospitals to acquire. However, with the introduction of new IoT technology this has fortunately changed. The new electronic hand hygiene monitoring systems gather and analyze large amounts of actionable data while providing real-time interventions and reducing the risk of citations. While there still appears to be a misunderstanding within healthcare decisionmakers that this technology is expensive, it has become surprisingly affordable and are becoming more so as time goes on. Most of these systems provide a high ROI due to the reduction in the number of infections as well as reduction in HAC and readmission penalties. When patients do not contract infections during hospital admission, their length of stay is shortened making it possible to treat more patients. Furthermore, the use of the antibiotics is reduced. With these financial advantages, hospitals are experiencing significant cost reductions which is also why we see now that hospitals are adapting the technologies at a faster pace than ever before.
- 5- Real-Time Intervention. Monitoring of hand hygiene performance is one thing but changing clinician behavior to actually improve results is something entirely else. A growing number of healthcare organizations are relying on real-time interventions to improve hand hygiene performance in the moment. Some interventions that reminds the healthcare workers to sanitize their hands by using lights, beeps, vibrations and/or even a human voice, yet due to poster blindness (fatigue) these interventions have shown very little impact. Instead, recent research has shown that using altering reminders (dynamic nudging) have a more sustaining impact on behavior . Real-time interventions can also take the form of notifications or emails that warn unit managers of hotspots, i.e. patient rooms where hand hygiene is unusually low which is often seen with patients in isolation due to clostridium difficile. This type of intervention can alert managers to high-risk situations, so they can intervene before a problem can spread. Interestingly, studies have shown that healthcare workers hand hygiene can improve significantly when patients remind the staff to sanitize hands . Major organizations such as the Centers for Disease Control, the World Health Organization, and the Joint Commission now recommend using patient participation as part of the plan to improve healthcare worker hand hygiene. Therefore, remember to speak up if you are admitted to a hospital and see that healthcare workers do not sanitize their hands.
The Bottom Line With dropping prices, a solid ROI and mounting pressure to improve hand hygiene, we’ll see more hospitals in 2019 moving away from the costly direct observation to leverage on actionable data and real-time interventions that can actually decrease the many healthcare-acquired infections.
Author: Theis Jensen is the founder and CEO of Sani nudge. The mission is to use the newest technology to lower healthcare costs and improve patient safety and quality of healthcare. Together with Aarhus University Hospital and Bispebjerg University Hospital, Theis leads the core development of the Sani nudge system. He holds a MSc. in Supply Chain and a MSc. in Engineering from the Technical University of Denmark and Aalborg University.