Will 2019 be the year of fewer hospital acquired infections?

Health care professionals know the vital importance of hand hygiene in preventing the spread of disease in health care settings. In the day to day life of most, the simple act of washing hands can dramatically reduce the spread of bacteria in any hospital setting.

Why is this important? According to the World Health Organization, “Hand hygiene is not a luxury.” Many illnesses and diseases spread through contact with other people, pets, and everyday objects. One of the easiest and most effective ways to prevent this spread is braking the chain. Even though most people know this is done with hand wash it is still not normal procedures in hospitals.

Although methods to improve hands washing has not been fundamentally changed in over a century, there is finally starting a new trend. I will in this post walk you through  the top five hand hygiene trends to look forward to in 2019.

1.     Direct Observation is so 2018. Partially due to the increased pressure from the Joint Commission, finally hospitals are quitting the use of secret shoppers to monitoring hand hygiene performance with direct observation. To most infection preventionists it is no secret that direction observation only provide invalid data and have no effect on hand hygiene compliance.

There are many reasons direct observation doesn’t work. A multitude of human biases are involved, such as the Hawthorne Effect in which providers who know they’re being watched are three times more likely to clean their hands.  In addition, the sample sizes are typically <1%. And as we like to say, “you don’t make a chicken fatter by weighing it.” That is, any method to simply monitor hand hygiene performance – direct observation or otherwise – does not change nor improve the results.

Many hospitals continue to submit misleading data that shows hand hygiene performance rates above 95 percent, yet HAI rates keep increasing and many of these hospitals are even on the HAC (Hospital-Acquired Conditions) list. If the nationwide average for hand hygiene is below 50 percent yet a hospital are at 95 percent, but  also on the HAC list, in it is hard to believe their hand hygiene compliance is true. The leading hospitals will in 2019 face the fact that this data is seriously flawed and get leadership support to fix it. 

2.     Penalties as motivator. Last year, the Joint Commission intensified the pressure for hospitals to improve hand hygiene by introducing new guidelines. In line with their notice, surveyors have issued citations to hospitals nationwide after observing a single failed hand hygiene opportunity. This results in potential revisits and could even put the hospital’s accreditation at risk. Therefore, hospitals will be more serious about making immediate and significant improvements in hand hygiene performance in 2019.

3.     Actionable Data as a standard. Food manufactures, airports and shopping malls is just some of the industries that have been using Internet of Things (IoT) and big data to revolutionize their industry and now IoT is beginning to transform healthcare as well. When used to monitor hand hygiene performance, IoT sensors and other technology can capture hand hygiene performance data without bias, unlike direct observation. This data can be analyzed in new and exciting ways, with cutting edge visualization that makes it possible for healthcare managers to identify how to most efficiently change hand hygiene behavior in their facility.  

Many electronic hand hygiene technologies integrate with electronic medical record systems, to automatically sync patient condition with hand hygiene protocols in the system. This combined data can be used to identify the most at-risk patients for targeted real-time interventions and inward precautions.

4.    Lower Costs. Electronic hand hygiene systems that gather and analyze reams of actionable data, provide real-time interventions and reduce the chance of a citation have been very expensive for hospitals to acquire. But with the introduction of new IoT technology, this has changed. While there still appears to be a misunderstanding within healthcare that this technology is expensive, it has become surprisingly affordable and becoming more so as time goes on. Most of these systems provide a incredible ROI due to reducing infections, reducing HAC and readmission penalties, shorten length of stay leaving space to treat more patients and eliminating the need for staff to spend precious time doing direct observation. With these financial advantages, hospitals adopting electronic hand hygiene systems are experiencing significant cost reductions. Which is also why hospitals are adapting at a faster pace than ever before.

5. Real-Time Intervention. Monitoring hand hygiene performance is one thing but changing clinician behavior to actually improve results is something else entirely. 

A growing number of healthcare organizations are relying on real-time interventions to improve hand hygiene performance in the moment. Some include reminding providers to sanitize their hands by using lights, beeps, vibrations and/or even a human voice yet due to poster blindness these interventions have shown very little impact. Instead, recent research have shown that using altering reminders have a more sustaining impact.

Real-time interventions can also take the form of text messages that warn unit managers of hotspots – patient rooms where hand hygiene is unusually low, particularly for patients in isolation or with C. diff. This type of intervention can alert managers to high-risk situations, so they can intervene before a problem can spread. 


With dropping prices, a solid return on investment and mounting pressure to improve hand hygiene, we’ll see more hospitals in 2019 moving away from costly direct observation to leverage actionable data and real-time interventions that can actually decrease the many hospital acquired infections 

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