Hand Hygiene

Taken from Becker's Hospital Review:
Here, Gina Pugliese, RN, MS, vice president of the Premier healthcare alliance's Safety Institute, explains why hand hygiene should be a patient safety priority, and how healthcare organizations can succeed in improving hand hygiene compliance.
Question: Patient safety includes a wide range of issues, from patient falls to medication errors and hospital-acquired infections. What one patient safety issue do you think should be a priority in hospitals and health systems?    

Gina Pugliese: Hand hygiene is one of the most important patient safety issues today. And, it is the single most important factor in preventing the spread of pathogens and healthcare-associated infections. Low compliance with this basic patient safety measure may represent a lack of compliance with other patient safety practices. Despite attention to public reporting, reduced reimbursement initiatives for certain healthcare-associated infections, and international attention by public health, professional and accreditation organizations, it has been a challenge to reach and sustain hand hygiene rates over 80 percent in many healthcare facilities.

Q: What are the biggest barriers to improving hand hygiene?
GP: All the systems must be in place to support hand hygiene and make it easy for staff to adhere. This includes staff education on the importance and indications for hand hygiene; convenient location of sinks and dispensers; all dispensers in working order and filled with hand hygiene products that are not drying or irritating to the skin and [that are] acceptable to staff. 

Q: What are the biggest opportunities for improving hand hygiene?
GP: The organizational culture must have the right balance between no-blame and individual accountability for noncompliance with safety practices. In most high reliability industries, such as the airline industry, once a reasonable safety rule has been scrutinized for strong evidence to support it, found to have no unintended consequences and then becomes implemented, a worker who fails to follow the rule becomes accountable for failure to comply. There needs to be a consistent, fair and transparent method to monitor adherence to recommended practices for hand hygiene and the behaviors for which staff will be held accountable.  

Some hospitals have been very successful with incentives and rewards to improve hand hygiene compliance. Any penalties for failure to adhere to patient safety standards must be understood by all staff and applied fairly and proportional to the infraction. Penalties are not intended for a busy or distracted caregiver that may forget to wash their hands, but rather habitual and intentional failure to perform hand hygiene despite education, repeat counseling and corrections of any identified systems issues. Penalties for failure to adhere to appropriate hand hygiene vary, and have included the linking of compliance to merit increases for salaried staff and temporary loss of clinical privileges for physicians.