Infection Control Today

SEP 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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36 ICT September 2018 www.infectioncontroltoday.com By Kelly M. Pyrek B ehavior modifi cation is shaping up to be one of the most important ways to address suboptimal hand hygiene compliance in hospitals. A personal and insti- tutional accountability paired with the attitude that everyone is responsible for good patient outcomes is how high-performing facilities are achieving this organizational priority and performance expectation. As Dunne, et al. (2018) observe, "Echoing the lessons of Semmelweis in the 1800s, hand hygiene is frequently described as the most effective preventive measure for healthcare workers, especially when complementing effective hospital hygiene practices that ensure proper cleaning and appropriate use of disinfectants and antimicrobials. The recognized issue with poor hand hygiene compliance among healthcare workers, and reports of recontamination of previously chemically disinfected clinical surfaces through hand contact, place hand hygiene education and monitoring at the core of HAI prevention and control." However, they acknowledge the barriers to practice: "Workload, location of hand rubs and soaps, perceived quality, effectiveness and potential dermatological effects of hygiene materials affect compliance behavior." Dunne, et al. (2018) observe that while education, behavioral modification and hygiene product development are "important enablers of hand hygiene," they emphasize that "desired behavior compliant with good hygiene practice is arguably the most pivotal factor infl uencing success in prevention of HAI, whether it be surface cleaning or hand hygiene. Innovative technology-enabled tactics have been well described … More simply, and perhaps more accurately, direct observation of actual practice has remained a core tenet of compliance measurement, albeit that such assessment is labor-intensive and requires staff trained in its performance. We, like many others, face the challenges of implementing and evaluating interventions to overcome ever more frequent and clinically diffi cult outbreaks. Hand hygiene is a relatively simple activity, evaluated relatively simply. It is, therefore, not surprising that hand hygiene-mediated interventions have been frequently reported. It is reasonable to state that, irrespective of variability in study design quality, and acknowl- edging Hawthorne effects, these interventions typically result in benefi cial changes in hand hygiene compliance even if not necessarily sustained. Considering the credible evidence supporting use of multi-modal education and behavior interventions (including 'nudging') to successfully encourage desirable hand-hy- giene-compliant behavior, we suggest that prudence dictates that such interventions should become a required component of any future protocols assessing more elaborate or sophisticated approaches… Failure to adopt this proposed requirement, given the potential diversion of constrained resources, may represent lost opportunities to build on prior interventions and loss of potentially sustainable benefi ts." Understanding and addressing the compliance behavior of healthcare personnel has never been more important, especially for healthcare institutions seeking and maintaining Joint Commission accreditation. It has been nearly nine months since the organization announced on Jan. 1, 2018 that any observation by Joint Commission surveyors of individual failure to perform hand hygiene in the process of direct patient care will be cited as a defi ciency resulting in a Requirement for Improvement (RFI) under the Infection Prevention and Control (IC) chapter for all accreditation programs. Surveyors also have been surveying an institution's hand hygiene program to National Patient Safety Goal (NPSG) 07.01.01. This NPSG, introduced by the Joint Commission in 2004, requires healthcare organizations to: ✦ Implement a hand hygiene program ✦ Set goals for improving compliance with the program ✦ Monitor the success of those plans ✦ Improve the results through appro- priate actions Behavior Modifi cation is Key to Boosting Hand Hygiene Compliance, Avoiding Survey Defi ciencies feature Ò Behavior modif cation is shaping up to be one of the most important ways to address suboptimal hand hygiene compliance in hospitals.

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