The Joint Comission Update for Infection Control

Joint Commission: Patient safety is in your H.A.N.D.S.

Habit, Active feedback, No excuses, Data Systems

A hand hygiene project launched at The Joint Commission's Center for Transforming Healthcare cites the following problems and solutions on hand hygiene:

Causes of failure to clean hands

  • Ineffective placement of dispensers or sinks
  • Hand hygiene compliance data are not collected or reported accurately or frequently
  • Lack of accountability and just-in-time coaching
  • Safety culture does not stress hand hygiene at all levels
  • Ineffective or insufficient education
  • Hands full
  • Wearing gloves interferes with process
  • Perception that hand hygiene is not needed if wearing gloves
  • Health care workers forget
  • Distractions

Examples of how to link specific causes to targeted solutions

Cause: Ineffective placement of dispensers or sinks

Solution: Provide easy access to hand hygiene equipment and dispensers

Cause: Hand hygiene compliance data are not collected or reported accurately or frequently

Solutions:

  • Data provide a framework for a systematic approach for improvement
  • Utilize a sound measurement system to determine the real score in real time
  • Scrutinize and question the data
  • Measure the specific, high-impact causes of hand hygiene failures in your facility and target solutions to those causes

Cause: Hand Safety culture does not stress hand hygiene at all levels

Solutions:

  • Make washing hands a habit — as automatic as looking both ways when you cross the street or fastening your seat belt when you get in your car
  • Commitment of leadership to achieve hand hygiene compliance of 90+ percent
  • Serve as a role model by practicing proper hand hygiene
  • Hold everyone accountable and responsible — doctors, nurses, food service staff, housekeepers, chaplains, technicians, therapists

Cause: Hands full

Solution: Create a place for everything: for example, a health care worker with full hands needs a dedicated space where he or she can place items while washing hands

Solutions: Effective hygiene is in our HANDS (Habit, Active Feedback, No One Excused, Data Driven, Systems)

Habit

  • Always wash in and wash out upon entering/exiting a patient care area and before and after patient care
  • Make washing hands a habit — as automatic as looking both ways when you cross the street or fastening your seat belt when you get in your car

Active Feedback

  • Coach and intervene to remind staff to wash hands
  • Clearly state expectations about when to sanitize hands to all staff members
  • Communicate frequently — provide visible reminders and ongoing coaching to reinforce effective hand hygiene expectations
  • Engage staff — real-time performance feedback
  • Tailor education in proper hand hygiene for specific disciplines
  • Provide just-in-time training
  • Use technology-based reminders and real-time feedback
  • Celebrate improved hand hygiene

No One Excused

  • Protect the patient and the environment — everyone must wash in and wash out
  • Make it comfortable to wash hands with soap or use waterless hand sanitizer
  • Hold everyone accountable and responsible — doctors, nurses, food service staff, housekeepers, chaplains, technicians, therapists
  • Apply progressive discipline from the top — managers must hold everyone accountable for proper hand washing
  • Commitment of leadership to achieve hand hygiene compliance of 90+ percent
  • Identify proper hand hygiene as an organizational priority
  • Serve as a role model by practicing proper hand hygiene

Data Driven

  • Data provides a framework for a systematic approach for improvement
  • Utilize a sound measurement system to determine the real score in real time
  • Use trained, certified independent observers to monitor appropriateness of hand hygiene
  • Scrutinize and question the data
  • Measure the specific, high-impact causes of hand hygiene failures in your facility and target solutions to those causes

Systems

Focus on the system, not just on people

Make it easy; examine work flow of health care workers to ensure ease of washing hands:

  • Provide easy access of hand hygiene equipment and dispensers
  • Create a place for everything: for example, a health care worker with full hands needs a dedicated space where he or she can place items while washing hands
  • Limit entries and exits from a patient's room — make supplies available in room and eliminate false alarms that require staff to leave room to turn alarm off

Identify new technologies to make it easy for staff to remember to wash hands, i.e., radio frequency identification, automatic reminders, real-time scoring