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Intensified Hand Hygiene Highlights APIC 2017

Mike Mann's picture

Healthcare kitchens escape measured scrutiny

Immersion into the topic of hand hygiene to reduce operational risk, filled the agenda at the 44th annual conference of the Association for Professionals in Infection Control. The suspicions of the past have now been confirmed by so many respected authorities. Data does change hand hygiene behaviors in a sustainable way.

There was little dispute on the value of data and verified handwashing compliance but yet it was reported that only 3% of hospitals are currently using this advancement. In nursing homes, where 380,000 residents die annually from a home-acquired infection, it is virtually nonexistent. The usual reasons of cost and manpower were frequently cited as well as the objections to another intrusion of technology and its lack of reliability. Some referenced all the advantages of the direct observation protocol but this group did tend to concede that electronics added the statistical significance advantage by multiplying the observation opportunities. One hospital reported their capability to monitor 100,000 hand washings per day, thanks to automation.

Handwashing For Life Healthcare interprets this low penetration to be a function of five factors:

1. C-Suites are not convinced that more handwashing can make a difference in infection rates.
2. Having a number does not change behaviors.
3. Quality Assurance, Patient Protection and Infection Prevention are respected for their technical knowledge and passion but are less effective in convincing Operations and Risk Management to install an electronic solution.
4. Keeping up with the flood of regulations consumes key resources.
5. Inability to monetize the risk factor of the unwashed hand.

The intense focus on hand hygiene in the patient room has left the kitchen largely outside the net of current monitoring systems. The kitchen is not seen as a major source of healthcare infections yet In a recent study published in AJIC (American Journal of Infection Control) norovirus, frequently associated with food preparation, was identified as the pathogen most often responsible for shutdown/closure of a hospital unit/department.

The popular World Health’s 5 Moments for Hand Hygiene standard ignores the kitchen as a source. Infection Preventionists are content that the common practice of "Wash In. Wash Out” using hand sanitizer has improved compliance rates and provides a framework to track compliance in patient rooms. The intent of the 5 Moments is often replaced by the reality of 2 Moments - in and out.

Honesty was another notable theme at APIC 2017. How could an operation be serious about a path of continuous improvement without a baseline founded on reality? Handwashing rates in healthcare kitchens and patient areas appears to both be hovering around 30%. The FDA Food Code is apparently being meet sufficiently by culinary as their permits are regularly renewed  The Joint Commission audits are known for their rigor but yet approve the operations with 30% compliance, urging them to report reality rather than the 90% commonly proclaimed.