Healthcare-associated infections (HAIs) have a significant impact on patients and hospitals. In fact, they lead to increased morbidity and mortality and higher health care costs. In 2002, it was estimated that HAIs affected 1.7 million patients, led to 99,000 deaths, and were associated with more than $5 billion in excess healthcare costs.1
But proper hand hygiene has been recognized as the most important measure to reduce their incidence. 2, 3 Additionally, The Joint Commission (TJC) has highlighted the necessity of decreasing HAIs in National Patient Safety Goals (NPSG).7 The commission further specifies in NPSG.07.01.01 that hospitals must comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or current World Health Organization (WHO) guidelines. 4
Both the CDC Hand Hygiene Guidelines for Healthcare5 and the present WHO guidelines6 recommend that health care workers wash hands with soap and water when hands are visibly dirty, contaminated or soiled and use an alcohol-based hand rub for cleansing when hands are not visibly soiled.
Performing proper hand hygiene decreases the patient’s risk of developing HAIs. TJC mandates that accredited organizations monitor compliance, set goals for improvement and demonstrate improvement based on those goals.7 How are hospitals doing? What are the compliance rates? Keep in mind for purposes of this discussion compliance would be defined as performing hand hygiene according to the specific hospital policy. Graph 1 (below) shows a compilation of multiple studies that have been done to measure hand hygiene compliance.8
Why are compliance rates so dismal? Numerous explanations have been given over the years as to barriers that inhibit Health Care Workers (HCW) from performing hand hygiene. These include:
- Misunderstanding the guidelines
- Lack of hand hygiene supplies
- Busy schedules
- Hands full
- Understaffing and overcrowding
- Other patient needs taking priority
- Disagreement with the recommendations 9,10
A Success Story in Compliance
Many initiatives can be implemented to improve compliance in hospitals, which must be a priority. This requires a multimodal, multidisciplinary approach rather than a single intervention.11 One successful program developed and modeled by Memorial Sloan Kettering Hospital between 2008 to 2010 demonstrated a hospital-wide increase in hand hygiene compliance from 65% to 97%.12 The program included administrative or leadership support, standardization of workflow and clearly defined hand hygiene opportunities during specific tasks as well as standardization of the method for observing hand hygiene. The program also incorporated immediate feedback to staff regarding missed opportunities and expansion of the hours of observation and the occupational workgroups. The hospital has been able to sustain the improved compliance rate for three years now.
Hand hygiene is a vital responsibility of all who come in contact with patients. As the most important action that can be taken to decrease HAIs, it will lead to improved patient outcomes. So it’s a call to action for hospitals and the individual HCW to take responsibility and accountability to ensure that hand hygiene is an integral part of every patient interaction at every opportunity.