Joint Commission studies hand hygiene compliance
Joint Commission studies hand hygiene compliance
Experts seek best way to monitor HCWs
The Joint Commission wants you to measure compliance with hand hygiene. But if you feel unsure about the best way to do that, you're not alone. Even hand hygiene experts are struggling with how to monitor hand hygiene.
The Joint Commission in Oakbrook Terrace, IL, has convened an expert panel and plans to issue a monograph on monitoring hand hygiene in early 2008.
"There's a lack of consensus on how to measure hand hygiene compliance," says Linda Kusek, RN, MPH, associate project director of the Joint Commission's Division of Research. "This has made it difficult for everyone to actually determine the effectiveness of their hand hygiene program."
Yet hospitals are required to monitor compliance. One of the Joint Commission's National Patient Safety Goals calls for hospitals to comply with the hand hygiene guidelines of the Centers for Disease Control and Prevention. CDC specifically recommends monitoring the "number of hand-hygiene episodes performed by personnel" compared to the "number of hand-hygiene opportunities, by ward or by service" and providing feedback to employees about their performance. It also recommends monitoring the volume of alcohol-based hand rub or soap used per 1,000 patient-days.1 (See box below.)
CDC: Monitor hand-hygiene episodes, volume of gel The Centers for Disease Control and Prevention calls for the following monitoring of hand hygiene:
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To "monitor the episodes," many hospitals conduct periodic observation. This has its drawbacks, notes Elaine Larson, PhD, RN, associate dean for research at the Columbia School of Nursing in New York City.
"The problem with observation is that it's exceedingly expensive," she says. "It's also disruptive and there are issues of privacy. It also changes behavior. If you know you're being watched, you may change your behavior."
Some facilities place electronic counters in the soap or alcohol-based gel containers. It registers every time someone takes a squirt.
The problem: "You don't know who did it," says Larson. "If you wanted to do some kind of intervention to improve practice, you don't know who needs the intervention."
Measuring how much gel is used also poses difficulties. To make gel use convenient, many hospitals give health care workers small containers to carry in their pockets. They may take them home and use them at other times.
If you measure product use to determine hand hygiene, you also need to keep track of patient load, notes Larson. You would expect fewer hand hygiene episodes on days of lower patient population.
The Joint Commission's hand hygiene monograph is being developed with other organizations: the Association for Professionals in Infection Control and Epidemiology (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the World Health Organization (WHO) World Alliance for Patient Safety, the Institute for Healthcare Improvement (IHI), and the National Foundation for Infectious Diseases (NFID).
For now, hospital employee health and infection control professionals should use their best judgment about how to monitor hand hygiene.
"We do ask them how you go about monitoring hand hygiene and the surveyors will look at the data they've collected," says Kusek. "They'll also look at the issues the organization has identified as a result of that process to see if they've taken the next step to improve compliance."
Reference
1. Centers for Disease Control and Prevention. Guideline for hand hygiene in healthcare settings. MMWR 2002; 51 (RR16):1-44.
The Joint Commission wants you to measure compliance with hand hygiene. But if you feel unsure about the best way to do that, you're not alone.Subscribe Now for Access
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