Researchers at Henry Ford Hospital (HFH) in Detroit have discovered that pictures can be powerful motivators when it comes to hand hygiene. Specifically, infection control specialists have found that showing healthcare workers magnified images of bacteria that have been lifted from their own hands and surrounding healthcare environments have the power to boost hand hygiene compliance by anywhere from 22.9% to 142%, based on the results from four units in which researchers tested the intervention.1 It’s an important issue when one considers that poor hand hygiene contributes to healthcare-associated infections, a problem costing hospital systems nearly $10 billion annually, according to some estimates.
“We had been reading all these different articles about different ways to increase hand hygiene, and one of the methods kind of stuck out to us as something we hadn’t tried yet,” explains Ashley Gregory, MLS (ASCP), one of the researchers on this project and an infection prevention specialist in the Henry Ford Health System. “It involved using emotional motivators and, specifically, disgust.”
To study the approach, the researchers selected four units with low hand hygiene compliance rates. These included a neurosurgical ICU, two general practice units, and an observation unit, Gregory explains. Then, between July and September 2015, the infection prevention specialists visited each unit 10 times, during which specialists would swab various items as well as employees’ hands using an adenosine triphosphate (ATP) meter, a hand-held device that measures living organisms.
“We would hit every unit twice a week, and we did this for about a month,” Gregory says. “It became almost like a competition on the units.”
Leverage Competitive Instincts
While there was no guarantee that everyone working on one of the selected units would be subject to a hand swab, most eventually participated.
“If we went to a unit and one of the employees had not been tested, one of the other employees would point out what their number was and challenge the employee to see if he or she could beat that result,” Gregory explains. “They would point out the employees that had not [been swabbed and tested] yet.”
During each unit visit, infection prevention specialists would show unit personnel pictures from a compilation of 12 magnified images of bacteria that had been lifted from the unit. This was to demonstrate what the bacteria would look like under a microscope. It was enough to turn a person’s stomach, which proved powerfully motivating, essentially showing healthcare workers what they typically can’t see.
“When we were on the units, people would wash their hands even without us using an ATP meter on them just because the pictures grossed them out,” Gregory notes.
The result was a big boost in hand hygiene compliance, based on observations collected through the hospital’s stealth observer program, which involves unidentified observers secretly checking on the hygiene habits of personnel.
“They are noticing whether employees are washing their hands when they should be,” Gregory says, noting the average increase in compliance over all the units was 24%.
Employ Positive Reinforcement
It took some time for healthcare workers on the units to embrace the approach.
“It was a little slow to take off because people were hesitant. They would say their hands aren’t clean because they haven’t had a chance to wash them,” Gregory admits.
However, infection prevention specialists would respond that they wanted workers to know how dirty their hands were and what the bacteria might look like, because if something were to happen and they needed to rush to perform care on a patient, healthcare workers needed to know how important it is to wash their hands first, Gregory explains.
While healthcare workers initially were hesitant to participate, no one ever got defensive when confronted with the ATP results from their hands, Gregory observes.
“They might be disgusted or freaked out [by the pictures], but they would often go wash their hands and then ask to be tested again,” she says. “We would do that, and then they would be able to see that once they performed hand hygiene the amount of [bacteria] that we were detecting decreased significantly. It was positive reinforcement — hand washing does work, and it does help to get rid of the bacteria.”
Monitor Compliance
With the results from the intervention clear in the study results, infection prevention specialists have continued using the approach as a tool, and they are looking into purchasing more ATP meters to further leverage the intervention. For now, the one ATP meter they have is put to use whenever a unit is found to be struggling with hand hygiene.
“It increases hand hygiene almost immediately,” Gregory observes.
However, Gregory also notes that to have an effect, hospitals must pair the approach with effective compliance monitoring.
“If someone was not already using a stealth observer program, it would be hard to be able to evaluate whether the intervention is actually working,” she explains.
Also, HFH provides continual reminders to staff to always wash their hands before patient encounters. Overall, HFH administrators say the institution has a 70% hand hygiene compliance rate, a much higher rate than what is typical. The CDC estimates healthcare workers practice hand hygiene less than half the time they should. The agency suggests healthcare workers wash their hands as many as 100 times in a 12-hour shift, depending on the number of patient encounters.
REFERENCE
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Gregory A, Chami E, Pietsch J. Emotional motivators: Using visual triggers as an infection control intervention to increase hand hygiene compliance throughout the hospital. Am J Infect Control 2016;44: Issue 6, Supplement, P S3.
SOURCE
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Ashley Gregory, MLS (ASCP), Infection Prevention Specialist, Henry Ford Health System, Detroit. Email: [email protected].
