Is 100 percent compliance on hand washing possible?

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What would it take to move the dial closer to 100 percent compliance on hand washing? And just how realistic is that goal?

"Getting to 100 percent hand hygiene compliance through volunteerism is pretty unlikely," Dr. William Jarvis, an infection control specialist and president of Jason and Jarvis Associates, a healthcare consulting firm based in Hilton Head, S.C., told FierceHealthcare.

Part of the problem is that most physicians and nurses are not adequately trained in infection control, he said. They may not realize that hand washing is one of the best ways to fight hospital-acquired infections that are behind an estimated 99,000 deaths a year and some $30 billion in excess healthcare spending in the U.S. What's more, they don't like to be told what to do. And they don't understand how easily these pathogens are transmitted. "They just don’t get it," Jarvis said.
 
With most hospitals in the 40 to 50 percent adherence range, without a hospital administrator/government mandate or electronic monitoring, it won't happen, he said. But seatbelt laws and bike helmet laws offer a model to imitate.

A warning for a first violation, a fine the second time, and getting fired the third time would send a clear message, he said. But when the Joint Commission backed off its 90 percent compliance target, hospital administrators stopped caring. If a culture of patient safety were foremost, you wouldn't see hundreds of doctors or nurses fined, he said, because they would follow the rules.
 
When asked what it would take to get closer to 100 percent compliance, Vickie Brown, RN, MPH, CIC--a spokesperson for the Association for Professionals in Infection Control and an associate director of hospital epidemiology at the 785-bed UNC Health Care based in Chapel Hill--was cautiously optimistic. "I'm not sure anyone has found the magic bullet," she told FierceHealthcare. But what took place at UNC was "pretty darn amazing," she said.
 
"What happened there holds more promise than anything [else] they've tried, short of a miracle."
 
People will wash their hands 30 to 40 percent of the time to protect their own health, she said. The challenge is to move people beyond what they learned from their mothers to washing to prevent others from getting infected. Observation, feedback, insuring the right cleaning agents are available, leadership support and role modeling, and encouraging patients to insist that healthcare workers wash their hands can help. But these steps have not pushed the dial to 90 percent compliance. Covert observation can push hand washing to 70 percent, Brown said. But how do you get past that?
 
At UNC, when 90 nurses became infection control liaisons, ownership of hand hygiene shifted away from infection control and became the province of front line providers. They watch each other, provide feedback and correct each other. The liaisons' work to change the culture of their units helped some reach and sustain 90 percent or greater compliance in hand washing, Brown said.
 
"To me," she said, "the key to reducing hospital infections is--whether talking about hand hygiene or ensuring steps are taken to prevent surgical site infections--to ensure the clinicians providing care believe in it and accept infection prevention as a priority." That's one way to bring about a complete culture change within an organization. Unlike those infectious bugs, it sounds like it's worth replicating. - Sandra

Note: FierceHealthcare will not publish on Monday, July 5, due to the Independence Day holiday. We will be back on a normal publishing schedule Tuesday, July 6.

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