Smile! Your Handwashing Is on Candid Camera

William R. Jarvis, MD


May 21, 2012


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I would like to talk to you about an interesting study evaluating hand hygiene. It is a study by Armellino and colleagues[1] at a hospital in New York, where they observed hand hygiene. The compliance rate was approximately 60% at this hospital. They implemented an intervention in their medical intensive care unit where they installed cameras that viewed the sinks and the dispensers for hand-hygiene products. Sensors were placed at the doors to identify healthcare workers who were entering or exiting the rooms.

Data were captured and sent to a third party auditor in India. Compliance with hand hygiene was identified as hand hygiene performed before and after room entry. Before this intervention, the observed hand hygiene compliance was 60%. In the 16 weeks during which no feedback was provided, there were 60,000 hand hygiene events -- 3933 (6.5%) "passed," or were considered compliant -- and the compliance rate ranged from 3.5% to 9.8%.

In the next 16 weeks, the investigators provided feedback to the staff. This included 2 hallway LED boards that reported previous shift compliance rates and encouragement, but details were also provided to the nurse manager and to other healthcare workers approximately 3 hours after each shift. Data included 73,000 observations, of which 59,627 were categorized as "passed" (81.6%). Hand-hygiene compliance rates during shifts range from 30.8% to 91.2%.

In the 75-week maintenance period following the feedback period (during which feedback was still provided), there were almost 300,000 observations, 262,826 (87.9%) of which were compliant.

This study shows us several things. First, there should be considerable question about the validity of routine hand-hygiene observations; second, hand-hygiene compliance is probably much lower than most visual observations would predict; and third, through use of electronic or camera monitoring with feedback, hand-hygiene rates can be improved and sustained.

One caveat about this study is that hand-hygiene compliance was measured only upon entering and exiting the room. The most important time to be hand-hygiene compliant is during patient contact, and that wasn't being measured. However, this study provides us some excellent examples of where we should be going with hand hygiene and hand-hygiene monitoring and that is with video or electronic monitoring that can measure much better, more objectively, and -- most important -- all hand-hygiene events.

Until next time, this is Dr. William Jarvis, President of Jason and Jarvis Associates. Thank you for watching.


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