Improved hand hygiene means stricter monitoring, concrete penalties

Encouraging hand hygiene among hospital employees is a top priority in the healthcare industry, but improving it may require closer monitoring and the threat of penalties for non-compliance, according to a column at MedPageToday.

A recent Health Affairs blog post called for hospitals to make hand hygiene compliance mandatory, but providers must go further with their efforts, writes hospitalist Brad Flansbaum. While the blog post's suggestions are important, Flansbaum writes, the post makes no mention of penalties or monitoring. The two are closely connected, he adds, as hospitals need to observe employee behavior thoroughly to identify appropriate penalties.

Hospitals have several options for monitoring hand hygiene, Flansbaum says, including one or more of the following:

  • In-house or third-party monitors covertly and randomly observing employee behavior from ward to ward
  • Regular, unannounced on-site inspections by a regulatory body
  • Technology that continuously monitors compliance
  • Creating a culture that self-polices

It's also important to analyze hand hygiene noncompliance in context, Flansbaum adds. "We will need to aggregate data based on the totality of an individual's activity," he writes. "Gotcha moments for the errant slip … should not be the basis for penalties."

Further study is needed to determine the most effective monitoring system, according to the hospitalist. To start out, Flansbaum suggests assembling a small cohort of hospitals, matched according to geographic proximity, socioeconomic status, demographics and payer mix, and having them agree on a hygiene monitoring system. After several years of such a project, each hospital involved should publish its total scores, with the worst performers accruing financial penalties.

Other experts have agreed that lack of concrete consequences hurts hand washing compliance, saying efforts to maintain positivity may keep hospitals from developing effective incentives against noncompliance, FierceHealthcare previously reported.

To learn more:
- here's the column

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