Quantitative Measurement of Hand Hygiene Behavior in Hospice Environments Using An Automated Personal Hand Hygiene System

Abstract

BACKGROUND Despite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS). METHODS The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. RESULTS Prior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8. CONCLUSIONS Implementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance. Despite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS). The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. Prior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8. Implementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance.