On a conceptual level, it’s the simplest thing in the world: in order to reduce healthcare-acquired infections (HAIs), clinicians, including nurses, physicians, and all others who touch patients directly, need to engage in consistent, thorough hand hygiene. Studies show over and over that consistent hand hygiene practices make all the difference between acceptable and unacceptable HAI outcomes in hospital-based organizations.
Yet in practice, achieving rigor in clinician hand hygiene is actually quite complicated and challenging. Clinicians are constantly on the move, constantly interrupted, and constantly multitasking. And in reality, they often forget to wash or cleans hands when entering patient rooms and patient areas in hospitals. Nor is this a minor problem: clinical journals have documented the fact that HAIs infect between 1 and 2 million patients per year in U.S. hospitals, leading to about 100,000 preventable deaths and $10-30 billion in unnecessary healthcare costs; and a portion of that total number of HAIs has been linked to inconsistent or sub-optimal hand hygiene practices.
Inconsistent hand hygiene certainly was an issue at Floyd Medical Center, a 304-bed community hospital located in Rome, Georgia. Indeed, Linda Huddleston, R.N., M.S.N., C.I.C., director of infection prevention at Floyd, spent literally a decade (she’s been director of infection prevention that long, and has been at the hospital for a total of 12 years), trying to create an effective set of hand hygiene practices, and until recently, had been stymied at every turn. The practical reality of getting clinicians to achieve consistency with hand hygiene seemed perpetually out of reach, as it has been at countless hospital facilities nationwide.
Finally, last year, Huddleston decided to partner with the Atlanta-based Clean Hands Safe Hands, which provides hospitals with an electronic hand hygiene reminder system. That system, when fully implemented, is promoted as being able to reduce HAIs by up to 60 percent, through the use of real-time voice reminders. The Clean Hands Safe Hands system was piloted on two units last June, and since then, HAIs have decreased by 75 percent on those units. Huddleston is working now with colleagues to expand the program across units in three hospitals across the Floyd Health integrated system, of which Floyd Medical Center is one of three facilities (the others being Polk Medical Center in Cedartown, Georgia, and Cherokee Medical Center, in Centre, Alabama). Huddleston spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the organization’s experience in this area; below are excerpts from that interview.
Can you tell me about your involvement in hand hygiene improvement efforts?
I’ve been looking at this type of technology for five years or more. We’ve had several vendors coming in through the years to demonstrate their products. In January 2017, we had four vendors come in, and we had everybody vote on which product they’d want, and we chose Clean Hands Safe Hands. And in June of last year, we started a six-month pilot on two units, our intensive care unit with 26 beds, and a medical pulmonology unit with 22 beds.
Why did you choose those two units in particular to pilot on?
Because of their infection data. And also, ICU, with the immune-compromised patients, they’re more at risk for infection. So in June of last year, we started the implementation the last week of that month, so really the data is key. You have to collect your baseline data first. And then there’s a voice we turned on in September, and that’s when we saw the big difference, when the voice was turned on.
What is it that turns the key in that regard?
The first couple of months, you’re collecting data to see how long it takes for a person to sanitize their hands and enter the room. They trigger a motion sensor, and they have a certain number of seconds set for that particular unit, telling them to sanitize their hands, and if they haven’t done so, they hear a voice message reminding them.
What are the main reasons for clinicians’ failure to sanitize their hands?
We did a study on that recently with our three hospitals, and found that they’re in a hurry, they forget—those are the two main reasons they don’t. It’s not that they don’t want to protect our patients. Also, a big thing is their workflow. That’s one of the things that this technology does for us, is that we can work on workflow. If they’ve got things in their hands, they can’t sanitize. And if I have a clinician who has 2,000 opportunities in a month and I have another clinician with 1,000 opportunities, then we need to look at the person with the 2,000 opportunities, and finding out why that person has double the opportunities.
What are you finding out?
What we’re finding is that the newer nurses don’t remember to gather all their supplies before they go in. One CNA is not sanitizing his hands when he picks up dietary trays, then he does so when he gets to the utility room.
What’s the solution?
The solution is that he should sanitize his hands when he enters the patient room, before he picks up that tray. Then when he goes into the soiled utility room, he can sanitize his hands again on his way out.
Do you have any statistics or metrics so far, on your progress in those two units?
Yes, we’ve decreased HAIs on those two units by 75 percent, after activating the voice reminder in September.
So basically, the voice reminder is making the difference, then?
Yes, that’s what’s making the difference. Again, the clinicians want to help people. When they forget, they need a gentle reminder.
Do you have any thoughts for healthcare IT leaders in hospitals, about what’s been accomplished?
What’s great about this product is that Clean Hands Safe Hands handles all the technology. It can do other things as well. One of the reasons why we chose this is that not a whole lot of pieces of equipment need to be placed in rooms; once you start placing equipment, things get lost. There’s minimum physical equipment to this technology. And then, for the CMO, we’re decreasing HAIs; and the CFO is more than happy, because we’re achieving cost avoidance around infections, and decreased lengths of stay.
What are your plans for the next two years, going forward?
We’re expanding to three other units: a medical vascular unit with 19 beds; to 3 East, a medical oncology unit with 10 beds, and 4 West, a 22-bed neurology and neurosurgery unit. We just started that project this week. The first two units are in phase 4, and these next two units will be in phase 1. I tried everything for ten years, and nothing had worked until now.
