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The Why Of Healthcare's Unwashed Hands

Mike Mann's picture

Would the owner of the problem please step forward

APIC 2018 provided the venue to check in with caregivers as to why handwashing compliance numbers continue to fall short of a safe level. (The research was sponsored by Chicago Faucets, creators of the best-in-class HyTronic™ faucet with its integrated hand-held data gathering device, Commander™.)

The overarching objective of this two part research was to give healthcare providers a simple way to gather cross-departmental views en route to a consensus. Collaboration among a small team of experienced professionals, deeply familiar with its operations and committed to an enduring solution, serves as a starting line for a meaningful track of Continuous Improvement. These tools break the inertia frequently facing the concept of reducing HAIs via enhanced hand hygiene.

This suggested collaboration has as a by-product the answer as to “Who owns the handwashing issue?" The “owner” must be identified and engaged in the process from the start. Only the “owner” can provide the sustainable fix. All handwashing stakeholders will be working together with frequent reports to the “owner”.

Participants were asked about both compliance levels and the quality of handwashing at their facilities. The instrument used was a graphic pictured below, requiring each participant to place a dot on the intersection of handwashing Frequency and Quality for their facility. (To facilitate onsite research, a blank version is available for downloading. The print size depicted here is 24” x 36”.)

The first fact you notice is that only one of the 42 facilities is at the 90% compliance level as commonly reported to The Joint Commission and that person admitted it was the “secret shopper” number. Visually, it appears that the median of both the Quality and Frequency is a tad under 50%, totally at odds with the providers’ likely patient-centric mission and vision statements.

This easily administered investigation helps guide training as well as screams for actual data and a collaborative reality-reset of Joint Commission reporting. Consider using this to wake up C-suite leadership in light of TJC’s new “zero tolerance” standard. Funding electronic handwashing compliance systems is clearly cheaper than direct costs of HAIs and their brand damage. Data becomes the driver of sustainable behavior change where success is rewarded and noncompliance is disciplined. 

In the second survey, participants were asked to vote for their top three reasons for the underwashing of hands in healthcare. Their chart provided these results, with Management Complacency, No discipline for noncompliance and Inconvenient/Shoddy handsinks garnering a total of 47%:  (A blank chart is available to facilitate onsite research.)

As with the previous exercise, this simple survey instrument can help raise C-suite awareness to a level calling for a sustainable patient-centric solution.