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.



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