In a recent study published in JAMA Network, hand hygiene compliance remains low, averaging 50% across hospitals nationwide. Some institutions have implemented automated monitoring versus direct observation which tends to capture few events and may lead to inaccurate measurements. The University of Chicago Medical Center (UCMC) implemented an automated hand hygiene monitoring system in 2015. An infrared sensor anonymously records all dispenser uses (numerator) and entries into and exits from the inpatient rooms (denominator) to estimate hand hygiene compliance for each inpatient unit. Graphical trends are displayed on centrally located unit monitors and weekly data are communicated through automated reports.
Hand hygiene compliance in UCMC’s new adult hospital was examined b day, week, and month, from September 2019 through August 2020. The hospital participating in the study admitted 1159 inpatients with COVID-19 during the study period, with a monthly peak in April. Before the pandemic, monthly hand hygiene compliance across all units was similar to the September baseline of 54.5%. During the pandemic, compliance reached a daily peak of 92.8% in March 29, 2020, across all units.
The hospital participating achieved daily hand hygiene compliance rates higher than 90%, peaking at 100% across cohort units, significantly above national levels and the institutional goal of 60%. It was determined that compliance surge was driven by fear and increased awareness of the importance of hand hygiene associated with the start of the pandemic, as well as fewer room entries and exits resulting room fewer patient visitors, remote rounding by clinicians, and nurse batching of tasks while in patient rooms. High compliance was not sustained and returned to baseline. The study suggests high compliance is possible, even with automated monitoring, yet difficult to sustain.
How are you managing hand hygiene compliance in your center? Do you have new and innovative technology such as these hand sanitizer stations? Are you monitoring compliance with “eyes on hands”? Bottom line, how compliant is your staff? Take a look at your infection control logs, as the pandemic wanes (thank goodness) so may your staff’s compliance! The fear factor is gone and this study shows that so is the compliance. Take the time, review your outcomes, talk to the QAPI committee and keep residents safe! Stay well, mask up indoors and stay tuned!