If the law of diminishing returns applies to hand hygiene, is achieving 100% compliance always worth the cost? Do you think there is a point at which the returns are less than the time or money invested in increasing hand hygiene compliance?

Healthcare organizations are starting to understand the importance to focus on their staff’s education and execution of hand-hygiene.  Multiple studies cite the correlation between an increase in hygiene compliance and a reduction in hospital-acquired conditions.

Unlike Electronic Health Records though, hand hygiene compliance is not a disruption to staff workflow.  Instead, hygiene compliance is a essential principle of the Hypocritic Oath and in theory, should put more flexibility back into the hands of healthcare workers through reduced complications, lengths of stay, etc. 

So, how do hospitals strike the delicate balance between being a fair and just culture when dealing with hygiene compliance rates?

Is 100% compliance the goal?

Imagine that you had to repeat a simple task 100 times during a workday. Do you think you would be able to do it correctly time every single day? Imagine there was constant distractions, do you think you would be able to do it correctly even half the time? Probably not. It is very difficult to trust the 95% +/- compliance data that hospital’s secret-shopper program produces on hand hygiene compliance today especially if you are currently on the Medicare HAC penalty. Healthcare workers by nature are extremely competitive individuals with positive intent when they go to work every day.  If one of your patients suddenly goes into cardiac-arrest though, is hygiene compliance going to be the first thing on a healthcare worker’s mind? 

The worst cases are the biggest driver for creating a fair and just safety culture. Objective data can be used to influence people to change their behaviors and comply with evidence-based care guidelines. Hygiene monitoring systems are complementary to creating that culture of accountability. However, leadership must recognize the importance of not letting perfect be the enemy of good. Today’s hand hygiene compliance is bad, with the help of technology it can at least be good.   

The impact on patient care obtaining 100% compliance will have.

When dealing with a exceptionally contagious pathogen, there is a need of continuing to strive for 100% compliance. However, studies reveal that if rates are at 80%, increasing them to 90% seems to be less effective.  

But, there are other goals that we can achieve at 80% compliance rather than striving for 100%.  These include:

  • Decreased Hospital Acquired Infections
  • Decreased length of stay
  • Bed availability
  • Equipment availability
  • Reduction in testing and procedures

What makes the most sense?  The “law of diminishing returns” does exist in hygiene compliance!

With that taken into consideration when measuring hand hygiene compliance 24/7/365, 80% compliance should be the gold standard that hospitals should strive for.

At the end of the day, we have to start somewhere on the path to reducing the almost $10 Billion impact of just the top 5 HAIs on the US Healthcare system annually.  Hygiene compliance is a no-brainer so let’s start by striving for good, for now!