It's Burke's hope that one day, hospitals will treat hand hygiene at the bedside like the operating room.

"If a surgeon walked in off the street and into an operating room and started to pick up a scalpel, he would be tackled before he could get to the patient in the operating room. And yet, people can walk up to a bed in an ICU, walk right in and stick a filthy stethoscope on a patient and walk out; nobody stops him. How do we get the general floor bed to be like an OR? That's the vision we had for this," Burke said. "Hand hygiene throughout the facility is just as important as scrubbing in for the OR. We're [the industry] a long way from that."

Healthcare workers should be educated about contamination on all things, including the bedside table, the tug cord on the lamp, the privacy drapes, the water pitcher, among other things in the patient's room.

"Everything in the room has to be considered contaminated ... you have to think [about] all of this stuff. Just because you walked into the room and didn't touch the patient doesn't give you a [pass] on hand hygiene."

Using the science behind the new testing and the implementation helped gain buy-in from staff, Burke explained.

Burke warned other organizations testing similar hand hygiene improvements, however, that each culture is different, and what may work in one culture may not necessarily work in another. The key is to test what you implement and then implement what you test, he said.

Tips for improving hand hygiene

• Welcome ideas from front-line staff: Gather ideas from physicians, nurses and other health professionals. Every idea could be beneficial.
• Provide standard auditor education: Offer a standardized course for safety coaches in how to properly identify opportunities for hand hygiene. Doing so will help establish current compliance rates.
• Audit outside your environment: Use the standardized audit process in which auditors work outside their department or unit. Because people are likely to have biases, Burke recommended switching locations to gather meaningful data about compliance.
• Aim for near-100 compliance: When asked if 100 percent compliance is ever possible, Burke said it's not possible because people are human, but he acknowledged the goal is to reach near-100 percent. "If your mom was lying in an ICU with lines in everywhere, would you be happy with 1 out of 100 times people didn't bother to do something as basic as cleaning their hands?" Burke said. "The patient needs better than 95 percent," Burke said. "Ninety-five percent isn't close to where we want to be. Ninety-nine percent isn't close to where we want to be. We need 99.995 percent level of compliance if we're going to deliver to our patients the kind of environment they expect reasonably of a healthcare institution." Perfection may never be possible, given that everyone in healthcare is prone to human error, but near-perfection is always the goal.

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