100 Percent Hand-Washers at Hospitals? Not so Fast. Technology Gives The Real Score

When I worked for a healthcare business-to-business magazine a few years ago, it was the rage that hospital workers should wash their hands. Of course, they should. Hospitals were touting they even hired workers undercover to catch all the would-be non-hand washers. Lots of handwringing, I’m sure, was going on.

Despite the hoopla awhile back, healthcare hand hygiene compliance remains below 40 percent, according to the World Health Organization. Unwashed hands may have millions of bacteria on them, and can cause infections, disease, and even death. Think of this: 80 percent of hospital staff that dressed wounds infected with MRSA carried the organism on their hands for three hours.


At hospitals, they’ve often used the “hidden spies” approach to doing a better job of getting rid of the hidden germs. Undercover colleagues would be named as part of a team to check in whenever co-workers used the restrooms or other areas after leaving surgical or other units, and make note whether they washed their hands or not. Studies are now showing that’s not really a too effective approach, and doesn’t do a good job of finding out what’s really going on.

Riverside Medical Center in Kankakee, Ill, is among a growing list of hospitals using technology, specifically an electronic hand hygiene compliance system, in this case operated by a company named  DebMed that evaluates the true amount of hand-washing going on. And you know what? It’s a plan that’s working, the hospital says.

The process starts this way. No spies needed. Well, human anyway. A computerized chip is put into soap or sanitary dispensers that sends signals through a wireless network to a DebMed database and calculates hand-washing usage, versus opportunities in specific areas of a hospital through the day. Real-time data is then sent through dashboards at the hospital that officials can monitor. DebMed touts its system as providing accurate and unbiased hand-hygiene compliance.

While Riverside was extremely confident in its method of undercover hand-washing checks, its officials discovered after implementing the DebMed system they weren’t doing as well as they thought.

Before DebMed, hospital officials believed they were having a hand-washing compliance rate of some 90 percent or more. The DebMed system found it was more like 57 percent, which was, “frankly, a little shocking,” says  Michael D. Mutterer senior VP, CNO. Mutterer couldn’t get over it. “It was puzzling. Our organization has been very quality driven. We had a false sense that we were doing an amazing job, guys.”

As a leader, he’s thinking: what’s wrong with the data? “Truly, we’re not a 57 percent organization for anything,” he thought to himself. As a result, Mutterer says, “We all knew we had a false sense of what we were doing. We knew we had to get these numbers up, it wasn’t an option.”

Using the DebMed system, Mutterer says, vast improvements have resulted. So far, the hospital is up to 80 percent – not where they want to be, but getting there.

“We always knew what we could do; what we do here is a focus on quality and safety, and one of the first things is about hand hygiene.” The hospital launched a team-focused effort, a “positive way to implement the system, and not nurse specific or punitive in nature,” he says.

The dashboards give Mutterer reminders, including some “dings” at 3 a.m. on his computer – the compliance report, telling him how things were going.

“One of the really nice things about (the DebMed) it doesn’t go to the person level, and it’s not punitive. It’s not the same as watching your peers and have to say ‘after you left that isolation room, you didn’t wash your hands.’ ”

“It’s ingrained in our system now,” Mutterer says. The goal? 100 percent, of course.


Soap vs. Hand Dispensers 

Wherever you are, washing hands with plain soap and running water is one of the most important steps that consumers can take to avoid getting sick and to prevent spreading infections to others, so says the CDC. If soap and water are not available, the CDC recommends using an alcohol-based sanitizer that contains at least 60 percent alcohol.

But what kind of soap should you use? That may be the rub.

Recently, the FDA issued a proposed rule requesting “additional scientific data” to support the “safety and effectiveness of certain active ingredients used in topical consumer antiseptic rubs, including hand sanitizers.”

Based on new scientific information and reviews by medical and scientific experts from an advisory committee, the FDA wants to be sure that these antiseptic rubs really reduce bacteria on the skin.

As a result, the agency is requesting manufacturers provide data for three active ingredients — alcohol (ethanol or ethyl alcohol), isopropyl alcohol and benzalkonium chloride. Since 2009, 90 percent of all consumer antiseptic rubs use ethanol or ethyl alcohol as their active ingredient, the FDA said.

“Today, consumers are using antiseptic rubs more frequently at home, work, school and in other public settings where the risk of infection is relatively low,” said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

“These products provide a convenient alternative when hand washing with plain soap and water is unavailable, but it’s our responsibility to determine whether these products are safe and effective so that consumers can be confident when using them for themselves and their families multiple times a day.”

“To do that, we must fill the gaps in scientific data on certain active ingredients,” Woodcock said.

The proposed rule does not require any consumer hand sanitizer products to be removed from the market at this time. Instead, it requires manufacturers who want to continue marketing these products under the OTC Drug Review to provide the FDA with additional data on the active ingredients’ safety and effectiveness, including data to evaluate absorption, according to the agency.



Millennials Muddied On Insurance Coverage – Help Mom!

While the Department of Health and Human Services has rightly bragged about the widespread increase in insurance coverage among Americans, there is a big problem in this country when it comes to insurance for the millennials, findings show from a recent research report from Transamerica Center for Health Studies (TCHS).

Yes, our future.

Millennials generally have a lack of knowledge about what’s involved in complicated insurance policies, the costs involved, never mind too many skipping health checkups altogether or not even bothering to get coverage.

Luckily, some millennials are relying on mom for advice: no surprise there, according to the new TCHS report, Millennial Survey: Young Adults’ Healthcare Reality (We’ll get to that in a bit). TCHS is a division of the Transamerica Institute, a national non-profit that’s dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide.

At the outset, the survey numbers don’t seem bad.  Last month, HHS released a report that said the Affordable Care Act (ACA) resulted in about 20 million people gaining health insurance coverage between the passage of the law in 2010 and early 2016 – a historic reduction in the uninsured.

“Thanks to the ACA, 20 million Americans have gained health care coverage,” said HHS Secretary Sylvia M. Burwell. “We have seen progress in the past six years that the country has sought for generations. “Americans with insurance through the Health Insurance Marketplace or through their employers have benefited from better coverage and a reduction in the growth in health care costs.”

Numbers Behind The Story

The good news is that millennials are becoming increasingly insured. Those uncovered dipped from 23 percent in a 2013 survey to 11 percent, according to the most recent TCHS report. Indeed, coverage gains for young adults began in 2010 because of the provision of the ACA that allows children to stay on their parents’ health insurance plan until they’re age 26.

The health system is counting on younger, stronger and healthier millennials to reduce costs, and, more importantly, keep themselves healthy. Yet the TCHS  report shows some troubling numbers, including:

•    Almost 50 percent of millennials admit to “minimizing healthcare costs” by skipping care.

•    More than 50 percent of millennials have been diagnosed with a chronic illness or heart condition. The most common conditions among the population are depression (17 percent), weight issues (15 percent) and anxiety disorders (14 percent).

•    About 21 percent of millennials are unable to afford their routine healthcare expenses. (Some 26 percent say they can afford it with difficulty).

• 66 percent of millennials believe that $200 plus premiums per month is unaffordable

•    A majority of uninsured are women (60 percent) and unemployed (68 percent).

The Reality

Mindy Hanson, 32, of Des Moines, Iowa, has been an example of that reality. With a husband and three small children – ages 10, 6, and 5 – she personally didn’t have insurance for more than four years, not unlike many people her age.  Her family was covered under her husband’s work policy, but it was too expensive for her. “It was very scary,” Hanson said of the time she was not covered by insurance.

“I actually broke my toe at one point, and we had a few hospital bills crop up.”  Whenever she felt sick, she went to a local community healthcare clinic and paid about $25 to $30 per visit. Hanson said she knows many people her age who don’t have insurance. “It’s cheaper to go to a walk-in clinic and pay them.”

For the health system generally, “the challenge going forward are the uninsured millennials, who are needed in the market because they are generally healthier, and use their healthcare less to offset older and less healthy consumers,” said Hector De La Torre, Executive Director of TCHS.  “The ACA has helped reduce the uninsured population among millennials,   but affordability and access remain a concern,” he said. The problem is not only the uninsured, other underlying factors, are involved, the report shows:

•    55 percent of the uninsured are “not at all or not very informed about the healthcare insurance options available to them.”

•    52 percent of the uninsured millennials have been uninsured for more than two years.

•    47 percent of the uninsured millennials don’t plan on having health insurance in 2017.

“Some changes can be made to improve insurance prospects for millennials,” De LaTorre said. That could include comparison-shopping through health plans and services for consumers in Exchanges, he said.  (About 37 percent of millennials have comparison shopped for health insurance, he adds).

“Getting them insured is going to take direct (phone or face-to-face) communication and education,” De La Torre said of millennials.  “Of those who rely on family and friends for health information, their mother (or stepmother) significantly outranks everyone else” in helping them make insurance decisions, he added. Hanson would second that.

She felt obtaining insurance information was not only confusing, but “the information was just not as available as I thought it would be,” she said. “There are some  websites I’ve gone to, there is so much information you don’t know what pertains to you and what you don’t need to know.”

And for Hanson, mom was the best go-to for insurance advice.

“I got a lot of information from my mom, she’s in the insurance industry and the one I relied on for my questions,” she said.

Hanson is now covered by her husband’s insurance.