New Approaches to Hand-Washing Compliance

Hand-washing compliance is a big issue for today’s health care facilities, and for good reason. The recent news about lethal, antibiotic-resistant CRE infections is yet another reminder that hospitals, clinics, nursing homes and other care providers must do everything in their power to stop the spread of germs that put patients’ lives at risk and, according to the U.S. Department of Health and Human Services, “cost the U.S. health care system billions of dollars each year.”

Despite the evidence that hand washing is effective in reducing the risk of hospital-acquired infections, studies have shown that doctors, nurses and other health workers fail to follow proper hand hygiene more than 50 percent of the time. This is a sobering statistic. When it comes to a deadly strain of bacteria like CRE, even 95 percent compliance is not good enough.

So, the question remains: How can health care facilities get their workers to follow proper hand hygiene procedures more consistently?

Poor compliance is not a knowledge problem; it’s a behavior problem.
Many hospitals already have hand-sanitizing stations on the threshold of every room. They also post signs everywhere reminding people to wash their hands and even ask patients themselves to prompt their caregivers. Yet these measures alone don’t seem to be doing the trick. Health workers know hand washing is important — they’re not deliberately trying to put patients at risk. The reality is that hospital environments can be chaotic and busy. People get tired. They get distracted. They forget. This is why education-based efforts at increasing compliance often fall short, as they are aimed at informing caregivers of the importance of hand washing rather than at modifying behavior.

Taking the human error factor out of the equation.
Human beings are not machines. When it comes to repeating a task consistently, 100 percent of the time, humans are subject to error. Reducing the human error factor is critical to changing behavior and increasing hand washing compliance. Unfortunately, many of the approaches used by health care facilities to address the issue are also equally susceptible to human limitations. “Hall monitors” are a great example. Some hospitals hire observers to monitor health care workers as they enter and leave patients’ rooms, in order to track who is and who is not washing hands.

The problems with this technique are pretty clear. It is simply not feasible (from a practical or financial standpoint) for facilities to deploy human monitors to track hand washing in every situation. They can really only catch a small fraction of overall compliance infractions. Plus, hall monitors are subject to the same foibles as the health workers they are supposed to be watching. (They get tired, they get distracted and they miss things.) Campaigns designed to get patients involved in compliance efforts also suffer from human-related issues.

According to research reported in the December 2012 issue of Infection Control and Hospital Epidemiology, a survey of 200 hospital patients showed that while nearly 100 percent agreed that health workers should wash their hands, only 54 percent said they would feel comfortable asking a doctor to do so and only 64 percent would feel comfortable asking a nurse. And here’s the kicker — a mere 14 percent of patients reported ever actually asking a nurse or doctor to wash their hands. Taking the human error factor out of the equation demands a more “machine-based” approach.

How technology can help.
There are a number of ways that technology can be used to change the behavior of health workers and improve hand washing compliance. Innovations ranging from RFID tags and sensors to data capture devices that track people’s activities in physical spaces can potentially be deployed to consistently (and cost effectively) monitor compliance, to analyze behavior patterns so that facilities can better understand why breakdowns occur and even automate hand washing reminders through alarms and alerts. For example, technologies adopted widely in the retail industry to better understand consumer behavior are showing promise in health care. By combining intelligent devices that capture data about shoppers with advanced analytics, retailers are gaining valuable insights that help them optimize in-store promotions, deploy staff where they are most needed, minimize register wait times and improve customer service overall.

These same technologies in a hospital setting can be applied to measure entrances into a patient’s room, analyze behavior at hand washing stations and count compliance infractions, providing answers to questions such as: How often is hand washing skipped? Who is non-compliant? Under what circumstances? Is compliance better or worse in some areas of the facility as opposed to others? Why?

Linking this knowledge to action, in real-time, is the ultimate goal. Technology is critical for this purpose as well — compliance procedures need to be automatic, consistent and disconnected from human stumbling blocks (such as embarrassment or shyness) for them to work. Imagine, for example, that a sensor on a caregiver’s uniform “beeps” when a data capture device sees that the hand washing station has been bypassed. The caregiver, who was likely just distracted or in a rush, is prompted to comply without being embarrassed by a hall monitor, their supervisor or a patient. Facility managers can encourage better habits without giving staff the impression that they are breathing down their necks. And patients are relieved of the burden of confronting a cranky doctor when they are not sure he washed his hands — the onus shouldn’t be on them to make sure hospital policies are followed. More and more automated options are available as the capabilities of wireless devices and analytics have grown increasingly sophisticated. In the era of the superbug, health facilities would be wise to give these emerging technologies a look. It will save lives.

Ralph Crabtree is Chief Technology Officer and Founder of Brickstream, a leader in behavior intelligence solutions for environments where people shop, gather, work and play. He is an expert on image-understanding technologies, focusing on people tracking, video surveillance and documents recognition applications.
 

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