Clean Hands, Clear Communication: How Nurse Leaders Ushered in Hand Hygiene Tech Tools

Health system is focusing on new technology and new innovations to improve patient safety, quality director says.

Although observations showed a 90% hand hygiene compliance across the health system where he is director of quality, Bill Cox, RN, CPPS, CPHQ, was skeptical.

"I would say, 'How are we at 90% when I see many gaps across the 15 hospitals?' " he says.

Cox decided to trial a cloud-based electronic hand hygiene monitoring network in which badges with sensors communicate to the network when a user enters and exits a patient room and records whether the user cleans their hands.

Indeed, Cox is tapping into technology for better patient safety while, at the same time, fueling cultural change at Hospital Sisters Health System (HSHS), a nonprofit headquartered in Springfield, Illinois, that operates a network of 15 hospitals and other healthcare facilities throughout Illinois and Wisconsin.

The hand hygiene technology showed that Cox's suspicions about the high compliance rate were correct.

Some nurse leaders expected the new system to show compliance rates similar to the 80–90% rate when hand-sanitizing observations were done by staff. They were taken aback when the technology revealed numbers that were much lower.

"Now they're seeing more of them in the 50s and 60s or 70%, and it's kind of a shock to them," he says. "I stress to them that this information is a realistic timeframe activity with the organization, not a snapshot, which is what they were used to seeing."

Once Cox's team and nurse leaders saw the trial success, HSHS installed the system in all 15 hospitals. Although COVID-19 disrupted the rollout plans, by December 2020, all 15 hospitals had the technology in place.

Leading a culture change

"Back in 2019, we made a decision as a health system to really start to focus on new innovations to improve patient safety," Cox says.

Initiating culture change that comes with new technology—even one as small as hand sanitizing—requires engagement and buy-in by nurse leaders, Cox says. Leaders need to be fully engaged in and believe in the project in order to fully support it.

It also requires clear communication.

"We let not only the leaders know, but the frontline staff, what was about to happen, what was going to come up in the next few months, what they could expect to see, and how it would impact their current process for care," Cox says.

For instance, the nurses learned that new hand hygiene technology didn't change their handwashing flow; the badge attached to their main tag simply captures the data.

"We didn't change their process around that at all, and that was a big selling point to get them to buy into it," he says. "It wasn't telling them they had to do something different."

The nurse leaders also helped frontline staff ease any worries they had about the new technology.

Some nurses had heard that the badge gave off waves that caused breast cancer, so Cox's team got accurate information from the company to show that wearing the badge didn't put their health at risk.

Many nurses questioned why they were being tracked and resented such watchfulness, he says.

"We had to do a lot of training and a lot of reinforcement and a lot of reassurance that this isn't Big Brother; that our true goal behind it is patient safety and colleague safety," he says. "Once they started to grasp that and once the nurse leaders started to speak that same verbiage to them, they got the gist of it much quicker."

Reinforcing success

One nursing aide, in the first two weeks of the change, had more than 1,200 observations and was 94% compliant, Cox says. They have since established the 90s Club, where employees who hit 90% or higher compliance in a month are recognized through HSHS' systemwide communications.

"That's so they understand that we do pay attention, and that we are proud of what they're doing," he says. "That's key in showing that engagement with these initiatives is not put into place just to cause them to do more work, but it's actually being watched and trended for ways to show that we are providing high-quality care."

Nurse leaders are responding positively to the new technology, he says.

"They're starting to trust the data now that we've had it for a few months," he says. "They're starting to understand the importance of the data, and they're starting to hold the staff more accountable for compliance with our hand hygiene policies." 

Where, previously, 100 observations may have been captured for the month, a hospital may now be capturing 10,000 observations for a month from the new technology, he says.

"So it's really a very unique opportunity to capture a true picture of what we're seeing," Cox says.

The successful hand-hygiene program has also opened the door for other patient-safety technology, such as predictive analytics, which will first be applied to fall prevention, Cox says.

"We're hoping will go live in the next few months with predictive analytics within our electronic health record that will help us identify who's the fall risk, and as their hospital stay progresses, adjust it based on our care that we give them," he says. "So, if we give them a medication that is known to cause higher risks for falls, then the score automatically adjusts itself so we can change our plan of care for that patient."

His team also is considering video surveillance for patients who are at a high fall risk.

"Getting a sitter in the room with a patient is, as you can imagine, quite costly," he says. "Newer technology lets you put a robot in the room, and it's basically a video camera that you point at the bed, or the area, and you can talk and interact with the patient and not have to have somebody physically sitting there."

Such technology allows monitoring of multiple patients at a time so they remain safe and staff is used more effectively, Cox says.

With each technology advancement at HSHS, Cox and his team know it will require getting early buy-in from nurse leadership.