Handwashing – variation not compliance


With ISO accreditation, procedures are perfectly as described 100% of the time.  There are records to prove it.  The records are audited and inspected.  Even when things don’t go to plan there are more records of the anomalies.

Here is a study of real-world compliance in handwashing – without ISO accreditation. 

Smile! Your Handwashing Is on Candid Camera

William R. Jarvis, MD

Data were captured and sent to a third party auditor in India. Compliance with hand hygiene was identified as hand hygiene performed before and after room entry. Before this intervention, the observed hand hygiene compliance was 60%. In the 16 weeks during which no feedback was provided, there were 60,000 hand hygiene events — 3933 (6.5%) “passed,” or were considered compliant — and the compliance rate ranged from 3.5% to 9.8%.

In the next 16 weeks, the investigators provided feedback to the staff. This included 2 hallway LED boards that reported previous shift compliance rates and encouragement, but details were also provided to the nurse manager and to other healthcare workers approximately 3 hours after each shift. Data included 73,000 observations, of which 59,627 were categorized as “passed” (81.6%). Hand-hygiene compliance rates during shifts range from 30.8% to 91.2%.

In the 75-week maintenance period following the feedback period (during which feedback was still provided), there were almost 300,000 observations, 262,826 (87.9%) of which were compliant.

This study shows us several things. First, there should be considerable question about the validity of routine hand-hygiene observations; second, hand-hygiene compliance is probably much lower than most visual observations would predict; and third, through use of electronic or camera monitoring with feedback, hand-hygiene rates can be improved and sustained.

One caveat about this study is that hand-hygiene compliance was measured only upon entering and exiting the room. The most important time to be hand-hygiene compliant is during patient contact, and that wasn’t being measured. However, this study provides us some excellent examples of where we should be going with hand hygiene and hand-hygiene monitoring and that is with video or electronic monitoring that can measure much better, more objectively, and — most important — all hand-hygiene events.

Until next time, this is Dr. William Jarvis, President of Jason and Jarvis Associates. Thank you for watching.

 
If inspectors had time to watch recordings would ISO compliance fall from 100%?
 
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