February 19, 2010

New method to track hand washing

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VUMC is implementing a new way to measure adherence to hand hygiene standards. (photo by Mary Donaldson)

New method to track hand washing

The Medical Board recently set out an official method for measuring staff and faculty adherence to hand hygiene standards in clinical areas of Vanderbilt University Medical Center.

The board, which oversees clinical practice at VUMC, stated that observation of staff and faculty hand hygiene practice applies both immediately before entry to the patient environment and upon exit.

For private or semi-private rooms, “entry” and “exit” mean crossing the door or curtain line. (For multi-patient rooms, observation applies only to those providers seen touching either “the patient or the environment.”)

The proposal was put before the board by Allen Kaiser, M.D., interim chair of the Department of Medicine and chief of staff for Vanderbilt University Hospital. He said the agreement should help answer questions about how hand hygiene observation applies when providers, staff and medical students enter patient rooms without intending to touch a patient.

“If you're not touching the patient and you're not touching anything in the patient's environment, there's nothing in the germ theory of disease that would require you to have washed your hands, so in that respect any rule for observation is going to be somewhat artificial,” said Kaiser, who is a founding member and past president of the Society for Healthcare Epidemiology of America, a health care safety group.

“But the only alternative to observation and reporting would be to ensure adherence directly by following every provider into every room.

“We all believe the germ theory these days,” Kaiser added, “but in many patient care contexts, we still have trouble getting providers to predictably wash their hands. I think that has to do with there being no immediate complications for the patient from non-adherence. And it's to be acknowledged that in most cases there won't be a complication — most times it doesn't mean anything.

“However, in the event that a harmful pathogen is transmitted to a patient, the results can lead to unexpected morbidity and even mortality,” Kaiser said.

The board's action follows the establishment of a stronger VUMC hand hygiene monitoring program.

Since October, more than 100 monitors have been logging 1,500 to 2,000 observations per month, returning a minimum of 20 observations per month for each VUMC hospital unit and each clinic staffed by 10 or more nurses.

“Hand hygiene remains the single most important clinical safety practice that we can improve upon,” Kaiser said. “Now, to the credit of our overall health system, it's finally agreed that the only way to have success is to have observers routinely counting and reporting adherence with the standards.”

For the three months that ended Dec. 31, adherence with hand hygiene standards was measured at 78 percent across VUMC clinical areas, on campus and off. (Comparisons with other centers aren't available, as there is no standardized method for collecting and reporting hand hygiene adherence.)

“Our goal is 100 percent adherence. Any time anyone works with a patient, he or she first needs to wash his or her hands. It's an ambitious goal, but I think we can attain it at Vanderbilt,” said Tom Talbot, M.D., M.P.H., chief hospital epidemiologist.