Implementing a hand
hygiene program that's rooted in the four E's Engage,
educate, execute and evaluate is a great way to get your health care
facility on the path to continuous quality improvement.
In this final video of our four part series, we'll cover another essential
facet of an effective program evaluating performance.
It's difficult to measure adherence through hand
cleaning protocols, and there is no single best method.
Credible data obtained through a variety of methods is often best to evaluate
the success of initiatives or to identify the needs of health care personnel
who are working hard to make sure their hands are clean.
Let's explore a few methods of monitoring and evaluating
hand cleaning that you can implement at your facility.
Direct overt observation occurs when the person conducting the observation
and the person being observed are known to one another.
For example,
when hand cleaning is included in a central line insertion checklist,
the person completing the checklist watches and ensures that the person
inserting the central line
has cleaned their hands immediately prior to opening sterile supplies.
Direct overt observation can also be used to evaluate
hand cleaning techniques of personnel during demonstrations of skill.
Techniques to evaluate include observing for the full coverage of hands
with alcohol based hand sanitizer, or that hands are scrubbed
for a full 15 seconds during hand-washing
because individuals are fully aware that they're being observed,
lapses should be immediately corrected to result in 100% adherence.
Direct overt observation should be used to assist health care personnel
in cleaning their hands the right way, especially just before high risk tasks.
Data collected by overt observation
should not be reported as a rate of adherence.
Direct covert observation is often
referred to as the secret shopper or the anonymous method.
In this case, the observer is not known to the person being observed.
While there are many ways to make this approach effective, direct
covert observation is prone to bias.
There are, however, a variety of steps that can be taken to minimize
bias, train all personnel that collect observations
on how to consistently identify adherence or non-adherence.
Select locations for observations that have a clear line of sight
to sinks or alcohol based hand sanitizer dispensers.
Schedule observations randomly and confidentially at times of the day
when activities by diverse personnel are likely to occur,
such as during patient rounds or a change of shift.
Limit the time spent observing to 15 minutes or less per session.
To promote a facility culture of speaking up.
Anonymous observers should have clear instructions
about how non-adherence should be addressed.
Confidential rapid debriefing of a unit supervisor at the end of an observation
session is one way to correct lapses immediately after observation.
Conducting observations that room entry and exit are adequate for data collection,
but should not be the focus of efforts
to educate personnel about when to clean their hands.
Data collected can be reported as a rate of adherence.
Statistical analysis for sample size can be used to determine the number of
observations needed to correctly observe a true change in hand cleaning adherence.
When observations are repeated over time.
Automated hand hygiene monitoring systems may provide valuable data.
These systems collect data at all times.
Among all health care personnel, certain systems provide just in time reminders
for personnel if a missed indication for hand cleaning is detected.
Some systems can even provide real time data to unit based personnel
so that they can investigate and respond to non-adherence as it occurs.
Personnel responsible for
hand hygiene programs should collaborate with those being monitored
to ensure that the data collected are useful for performance improvements.
Automated hand hygiene systems can be used to report rates of adherence
to hand cleaning, but they cannot evaluate technique.
Ongoing daily or weekly assessments
of the accessibility and functionality of hand cleaning supplies
also is an important part of effective hand hygiene programs.
This can include a variety of regularly occurring assessments like measuring
the amount of alcohol based hand sanitizer dispensed
If the sanitizer evaporates in less than 15 seconds of rubbing into one's
hands, then the dispenser did not provide a sufficient amount of sanitizer.
Alternatively, sanitizer can be dispensed into a medication cup
to measure its volume for consistency with the manufacturer's instructions.
Examples of other routine evaluations may include
the assessment of sinks to ensure they are not blocked by equipment.
Sink countertops to ensure they are free from patient supplies.
Splash guards to ensure
they are in place and sink drains to ensure water does not pool any
deficiencies can be noted and corrected using facility specific processes.
A critical part of the evaluation process
is sharing the results of your data and using your data for action.
By systematically translating your data and providing meaningful
feedback to the front line.
You can engage personnel, improve adherence to hand cleaning
and prevent infections.
For more information about hand hygiene,
watch the remaining videos in this four part series.
Or visit our website at cdc.gov/handhygiene