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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Reality Check: Joint Commission lowers hand hygiene standard

The touch of death in any given moment in a hospital may come from a ministering angel, literal “care” givers with a special place for patients in their hearts and transient colonies of some pan-resistant pathogen on their hands.

“Wash ‘em,” we command yet again, lest the operation be successful but the patient die. But surely in an age of patient safety, top-flight hospitals have hung a scowling portrait of Ignaz Semmelweis in the main lobby and long-since banished the bane of the infection preventionist. Right?

In a word, “no,” and don’t call me Shirley. Though ultimately a success story, a Joint Commission quality improvement project at eight “leading” hospitals has one startling footnote: the baseline hand hygiene compliance rate was a collective 48%. That’s right, we’re back to our old coin-flip analogy, and if you call heads the odds are slightly higher it’s going to be tails. (i.e., bread always hits the carpet with the buttered side down.)

“When we first started this project all the organizations thought that they were around 80% – 85%,” says Melody Dickerson, RN, MSN, a Robust Process Improvement (RPI) Black Belt at the Joint Commission. “It was only when we did a true non-biased measurement that we found exactly where we were [48%]. It was surprising and shocking, but when you look at the literature that’s about where most people are.”

The original goal of the project was to achieve and sustain 90% compliance. Collectively, the hospitals came up short, reaching 82% and causing the Joint Commission to rethink the wording in its hospital standards. Previously, the standard called for hospitals to demonstrate hand hygiene compliance at a rate greater than 90%. A hospital that failed to comply would receive a Requirement for Improvement (RFI) and have 90 days to show improvement to 90%.

“Because of this project, we now know how difficult it is to reach 80% -- let alone 90%,” says Dickerson. “Now the standard says the hospital `needs to work to improve compliance’”

Though the compliance level jumped an impressive 34% at the hospitals overall, the reality is that a disturbing number of patient encounters are still carried out with unwashed hands.

“It begs the question: Was greater than 90% even an obtainable goal when you consider where you’re starting from?” she says. “What we found through this process is that some organizations are greater than 90%; others have not had as great of success. A lot of that depends where you start from. “