Technology-Based Initiatives Increase Hand Hygiene Compliance

University of Michigan Health and Newark Beth Israel Medical Center have increased hand hygiene compliance significantly.

The results of two technology-based hand hygiene improvement initiatives were presented this week at the annual conference of the Association for Professionals in Infection Control and Epidemiology.

In the hospital setting, hand hygiene is critically important to reduce hospital-acquired infections and to prevent surgical-site infections post-operatively. Despite the benefits of hand hygiene, achieving hand hygiene compliance among healthcare workers can be problematic.

In August 2018, Ann Arbor, Michigan-based University of Michigan Health switched from using static charts to monitor hand hygiene compliance to using electronic dashboards to visualize hand hygiene compliance in real time at its 1,100-bed campus. The technology-based initiative uses business intelligence software to generate weekly and monthly compliance reports that can be filtered by hospital unit and role such as environmental services and nursing.

A month after the initiative was launched, hand hygiene compliance at 19 hospital units improved from the high 80% range to 95%. Compliance rates dropped to 86% in March 2021 because the program was paused during the coronavirus pandemic, but compliance has risen to 98% as of April 2023 through reintroduction the dashboards and real-time data sharing.

Covert observers play a crucial role in the hand hygiene efforts, says Marissa Yee, MPH, an infection preventionist at University of Michigan Health. "We have covert observers who are trained to monitor hand hygiene. They walk around the hospital and look for hand hygiene opportunities, which focus on entry into a patient room or into a bay area as well as when a healthcare worker exits these areas. The covert observers can enter their hand hygiene observation data through a web-accessible database on their phones or iPads."

Once the data goes into the database, it is fed into the business intelligence software, which automatically refreshes the online dashboards, so staff can access their most current hygiene compliance, she says. "Staff can look at their hospital unit, environmental services unit, patient food and nutrition services, and any ancillary department. We want people to be able to access their data in real time, so they have many opportunities throughout a month to review their hand hygiene compliance. The business intelligence software has allowed us to get real-time data out to frontline staff as well as leadership throughout the institution so they can remind staff about hand hygiene during daily management huddles."

With the technology, the health system can target hand hygiene interventions, Yee says. "This initiative has allowed us to see whether we need to target specific shifts, units, or roles throughout the institution. We can educate staff on a timely basis because we can see what we are observing in real time."

Staff members have easy access to the hand hygiene compliance data, she says. "The dashboards are available on the health system website. There are different filters to view a specific unit or department, specific months, and our adult hospital or our children's and women's hospital. Staff can subscribe to a dashboard on a daily, weekly, or monthly basis with a particular filter and have the dashboard pushed to their email."

Newark Beth Israel Medical Center initiative

Newark Beth Israel Medical Center, a 665-bed hospital based in Newark, New Jersey, that is operated by RWJBarnabas Health, launched an automated hand hygiene monitoring system in 2019.

After a 21-day baseline period in February 2022, the hospital deployed the automated hand hygiene monitoring system in eight adult inpatient units covering about 200 patient rooms. The monitoring system senses every opportunity for hand hygiene and counts actual dispenses of hand sanitizer to compute the compliance rate. Data from the intervention was collected from March 2022 to April 2023. During the intervention period, the median hand hygiene rate rose in all units, ranging from a 67% to 132% improvement compared to baseline. The average percent increase over baseline across the eight adult inpatient units was 98%.

As part of the intervention, the infection prevention team enlisted hand hygiene champions and unit managers who shared real-time data about their units during daily safety huddles with hospital leadership and during shift changes. The role of hand hygiene champions and unit managers in the initiative is focused on looking at hand hygiene behavior, says Ndubuisi Eke-Okoro, MSc, an infection preventionist and epidemiology specialist at Newark Beth Israel Medical Center.

"Taking full ownership of our hand hygiene is one of the tools to prevent hospital-acquired infections. Hand hygiene champions and unit managers cross check as soon as a healthcare provider or any healthcare worker is about to approach a patient space. That creates an awareness of hand hygiene when working in a patient space," he says.

Hospital leaders have played a pivotal role in the initiative, Eke-Okoro says. "As part of our journey to being a high-reliability organization, we have made hand hygiene a priority. As soon as we initiated the electronic monitoring system, all infection prevention departments announced the hand hygiene performance of the facility during the daily safety huddles. The senior leadership gave responsibility to unit leaders to announce hand hygiene compliance in their daily huddles. All leaders got involved if hand hygiene was going in the wrong direction."

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