1210. A Lean Six Sigma Approach to Improving Accuracy of Manual Hand Hygiene Observations

Abstract

Abstract Background Hand hygiene (HH) is widely regarded as the most important factor in preventing transmission of infections. Since 2012 our health system has utilized unit-based direct observation to measure HH compliance. Although direct observation is widely used and considered gold standard, the discrepancy between unit-based HH compliance (UB-HH) and Infection Prevention validation HH audits (IP-HH) was increasing over time. To understand the drift in HH compliance, we began a Lean Six Sigma (LSS) Green Belt project to improve UB-HH observation accuracy. Methods The IP LSS Green Belt team included nursing, respiratory care, and human factors, and analyzed factors leading to inaccurate UB-HH using LSS tools including the Voice of the Customer, process mapping, fishbone diagrams, and failure modes and effects analysis. We updated HH observer web-based education; implemented a new process to ensure observer training; and eliminated unit report card penalties for poor UB-HH. We implemented a new, more accessible observation tool, which provides a dashboard for real-time access to HH results by all staff. IPs began weekly validation HH audits. Results Baseline data revealed a 34% discrepancy between UB-HH and IP-HH compliance (95% vs 61%) over 4 different monthly validation events; only 27% of observers had completed web-based training. Goal conflicts were discovered: units were penalized for poor HH, yet the observations were unit level self-report. These results prompted design changes to the online tool and the process flow of UB-HH observation; units implemented the new program sequentially between 9/20 and 12/20. These changes resulted in 99% of observers being web-trained; however, between 10/21-3/22, UB-HH compliance averaged 98% (n=19,940), while IP-HH compliance averaged 53% (n=579) (difference, 45%). Conclusion Using multidisciplinary process improvement, we enhanced our manual HH observation processes; however, no improvement in HH accuracy was observed. Unit-based staff, who lack dedicated time for HH observation, are biased to document HH compliance over non-compliance, even with recent re-training in non-biased HH observation processes and elimination of penalties. To improve HH accuracy, we recommend either dedicated neutral HH observers or automated systems. Disclosures All Authors: No reported disclosures.