In July 2013, a large hospital in Greenville, South Carolina, experienced a cluster of six Clostridium difficile infections on a 32-bed unit for hematopoietic stem cell transplant (HSCT) patients. In prior months, the infection rate had ranged from 0–1 per month. Because HSCT patients are at greater risk of acquiring C. difficile—a spore forming bacteria—hospital policy calls for clinicians and staff members working on the unit to use soap and water for hand hygiene, not alcohol-based hand sanitizer. By giving staff real-time feedback on the use of soap vs. sanitizer and ensuring the proper protocol was followed, hand hygiene compliance increased significantly and rates of C. difficile dropped from 7.03/10,000 patient days to 2.38/10,000 patient days.
Robinson, N., Boeker, S., Steed, C., & Kelly, W. (2014, June). Innovative use of electronic hand hygiene monitoring to control a Clostridium difficile cluster on a hematopoietic stem cell transplant unit. Poster session presented at the meeting of APIC, Anaheim, CA.
Because alcohol-based hand sanitizers do not effectively destroy Clostridium difficile spores, healthcare workers should use soap and water for hand hygiene to prevent cross-contamination around patients with C. difficile infections. A hospital in the Midwest used an electronic hand hygiene monitoring system to determine how often healthcare workers complied with a protocol that required them to use hand sanitizer when working with C. difficile patients. Data from the system showed that 36% were using hand sanitizer. After activating cross-contamination alerts in the system, noncompliance fell from 36% to 2% of room exits. Because the system provides data on individuals, the hospital was also able to identify and retrain workers who continued to be noncompliant.
Wittrup, K., & Burba, M. (n.d.). Case study: Tracking and preventing the spread of C. diff with an automated hand hygiene system. Ann Arbor, MI.
A large study compared hand hygiene compliance rates using different methods of measurement—an electronic badge-based system using real-time location technology and direct observation—and reporting by group and individual. The study included 80 months of data from three hospitals, a total of 3.8 million hand hygiene events, and approximately 5 million hand hygiene opportunities. The mean rates of hand hygiene measured by direct observation at the three sites were 88%, 87%, and 92%. Baseline compliance (no special training or education) measured with the electronic system was reported at much lower levels: 47.8%, 50.5%, and 67.5%. Data from the electronic system was first reported as group rates and later as individual rates. Each step improved compliance, with the mean rate of compliance rising from 57.4% at baseline to 60.1% with group reporting and 82.9% with reporting by individual.
Buckner, J., Read, M., & Dykehouse, L. (2016, June). Individual monitoring increases hand-hygiene compliance in multicenter registry utilizing badge-based locating technology. Poster session presented at the meeting of APIC, Charlotte, NC.
The Joint Commission offers healthcare organizations a Targeted Solutions Tool (TST) for measuring and improving performance in specific areas, including hand hygiene. Greenville Health System in South Carolina had been using direct observation (DO) in conjunction with TST to improve hand hygiene and was dissatisfied with the results. In four units, Greenville replaced DO with an electronic monitoring system based on the World Health Organization’s My 5 Moments for Hand Hygiene and modified the TST. The electronic system allowed managers to provide real-time feedback to frontline staff about compliance trends. All units showed improved hand hygiene compliance, with three showing statistically significant improvement. The overall rate of compliance rose from 46.3% to 57.2% across a 16-month period.
Kelly, J. W., Blackhurst, D., Steed, C., Boeker, S., & McAtee, W. (2016, May). Use of targeted solutions tool (TST) and electronic monitoring to improve hand hygiene compliance. Poster session presented at the meeting of SHEA, Atlanta, GA.
Three healthcare facilities—a 126-bed branch of an academic medical center, a 443-bed community teaching hospital, and a 680-bed academic medical center—installed an automatic, continuous system to measure hand hygiene compliance after growing dissatisfied with results from direct observation. Baseline compliance rates, measured prior to training and education, ranged from 16% to 21.5%. Each site began reporting compliance rates by group, and stepped up to individual reporting once improvement with group reporting plateaued. After 10 months, compliance rates rose at the three sites to 64.7%, 72.3%, and 58.5%, for an average increase from baseline of 258%.
Increasing hand hygiene compliance with a continuous fully-automated monitoring system at three hospitals. (2014, November). Batesville, IN: Hill-Rom.