The Joint Commission, a US healthcare accreditation organization released new standards regarding hand hygiene failures during patient care. The goal is to eliminate insufficient hand hygiene as a cause for healthcare associated infections.

With the increasing issue of healthcare associated infections (HAIs) on the rise, many hospitals have started to pay more attention to this problem and consider solutions to help prevent it. Now the Joint Commission, a US healthcare accreditation organization released new standards regarding hand hygiene failures during patient care. This organizations mission is to help improve the safety and quality of care of patients through “evaluating healthcare organizations”, which will help them improve their performance.

The Joint Commission is an independent, non-profit organization that was founded in 1951 and now evaluates/accredits more than 21,000 healthcare organizations. This organization is one of the nation’s oldest and largest healthcare accreditation groups. If a hospital wants to be accredited and approved by the Joint Commission, they have to undergo an on-site survey by their team once every three years. With their history and deep roots, most hospitals in the US are utilizing this group to maintain their standards for patient quality and care.

What new standard have they released?

Effective on January 1st, 2019, any observation by surveyors that show failure to perform hand hygiene during the process of direct patient care will be cited resulting in a Requirement for Improvement (RFI) under the Infection Prevention and Control (IC) chapter for all accreditation programs. This new initiative is part of the organizations National Patient Safety Goal (NPSG), which seeks to prevent hand hygiene errors to prevent infections.

Most healthcare organizations know that hand hygiene is the most important method to prevent HAIs. Right now, the Commission looks into hand hygiene through the NPSG, which was introduced to the public in 2004. This program makes healthcare organizations go through several requirements such as:

  • Implement a hand hygiene program.
  • Set goals for improving compliance with the program.
  • Monitor the success of those plans.
  • Improve the results through appropriate actions.

If an organization fails to implement these requirements or improve hand hygiene programs, they will issue an RFI. This will require organization directors to submit corrective actions for the program, documents, etc. If they do not adhere to these standards, then they will not be a part of the Commission.

The new standard has been released since the NPSG program has been active long enough for healthcare organizations to “train personnel” that engage in patient care. The Joint Commission understands that there are many causes of HAIs but want to stop a lack of hand hygiene from being one of them since it is easily preventable.

What does this mean for hospitals?

With the increasing push by the Joint Commission to enforce higher standards for hand hygiene many hospitals, especially those who are part of the accreditation organization, are now required to pay much closer attention to hand hygiene in hospitals. Most hospitals right now utilize direct observations to look into average hygiene compliance rates for their departments but we know that this method has a lot of flaws. One of them is that you will not get the actual compliance rates due to the flaws in gathering hygiene data. Automated hygiene monitoring systems can be used to prevent these flaws but will need the involvement of the staff to improve hand hygiene levels no matter what.

With hospital budgets getting tighter, more institutions will look at ways to save money and avoid expenses. Preventing HAIs could be the best way to do that since they are very expensive and time consuming for the hospitals. Reducing this issue can benefit both hospitals and patients drastically and improving something as small as hand hygiene can make all the difference. In the end, hospitals will need to start enforcing their organization to implement better hand hygiene requirements or face the consequences of the ever-changing healthcare landscape.


https://www.jointcommission.org/issues/article.aspx?Article=IlZJaLJCiRBZC2IRvnKkJTqEEU2n1Rxv3fqmsKqKPb0=https://www.jointcommission.org/issues/article.aspx?

https://www.jointcommission.org/leadingthewaytozero.aspx