As nurses, we all understand hand hygiene is the best way to prevent hospital-acquired infections (HAIs). Unfortunately, however, random audits and observations have shown us there is much room for improvement in this area among healthcare workers.
At Morristown Medical Center, we have unit-based hand hygiene champions who had been responsible for completing monthly audits on hand hygiene compliance and submitting them to our Patient Safe Care Committee. These audits were not necessarily 100% reflective of our true hand hygiene compliance; sometimes the hand hygiene events are not witnessed by the auditor and, therefore, have false increase in compliance numbers.
New Technology for Change
Due to the variability and unreliability of paper tracking, the senior leadership of Atlantic Health System – Morristown Medical Center’s parent organization – decided to implement an electronic hand hygiene compliance monitoring system this summer at all of our hospitals. This system consists of wireless sensors mounted beside each soap and sanitizer dispenser that monitor the number of times healthcare workers and visitors perform hand hygiene. This number is then compared to the number of hand hygiene opportunities we should expect to see based on staffing numbers and patient census.
Using this information, the managers can view the overall hand hygiene compliance in their unit.
The units at Morristown Medical Center that were chosen to trial this compliance system were identified by the hospital-based Infection Prevention team based primarily on Clostridium difficile rates, but also on overall HAI rates. Those areas that were determined to have the biggest opportunity for improvement were selected for implementation of the compliance monitoring system.
The critical care units were also included because of the acuity of the patients and the inherent risk of developing an HAI that these patients face. Once the units were determined, the nurse manager of the unit and a physician were chosen to be the champion for that area. These champions are responsible for monitoring the compliance data, ensuring the benchmark is being achieved, developing an action plan to improve compliance, and keeping the unit team informed about performance.
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A Team Effort
The unit-based structure of the technology means the system focuses on a whole group instead of singling out specific employees. The focus among our staff has been on creating an environment where every individual models the correct hand hygiene technique and encourages their colleagues to do the same.
SAFETY FIRST: Brittney Daley, RN, uses the new hand hygiene technology to ensure compliance rates remain high. Kyle Kielinski/thanks to Atlantic Health System
All of our units have been tasked with developing a “code word” that can be used among our healthcare workers to signal to a peer that they missed an opportunity and need to wash their hands. The winning “code word” will be chosen by the Infection Prevention department, and the submitting unit will be recognized.
The implementation of this system has brought the importance of hand hygiene to the forefront and ensures all healthcare team members, patients and families are accountable for doing their part.
In the Surgical and Medical ICUs at Morristown Medical Center, we have seen an increase in our hand hygiene compliance after the implementation of the system. Hand hygiene is a topic in our monthly staff meetings as well as a daily topic of conversation during our multidisciplinary rounds and delivery of patient care.
While it’s too early to tell what the long-term impact of the compliance monitoring system will have, I am hopeful we will continue to see hand hygiene vigilance and improved patient outcomes.
Kristin Ospina is the SICU/MICU nurse manager at Morristown Medical Center, Morristown, N.J.