Why is good hand hygiene important?  Hand-washing is one of the most basic ways to reduce the risk of healthcare associated infections which helps to keep patients and staff safe.  Healthcare associated infections (HAI) cause significant sickness, death and increased cost.  They affect nearly 2 million individuals annually, causing 100,000 deaths, and increase patient care costs by an estimated $4.5 to 5.7 billion.  Transmission of harmful bacteria and viruses occurs most often through the contaminated hands of healthcare workers.  It is estimated that one-third of HAIs can be prevented through proper and consistent hand hygiene. 

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Numerous guidelines and recommendations support the practice, including the Centers for Disease Control (“Guideline for Hand Hygiene in Health Care Settings” 2010), the World Health Organization (“Guidelines on Hand Hygiene in Health Care” 2007), and the Institute for Healthcare Improvement (“Improving Hand Hygiene: A Guide for Improving Practices among Health Care Workers” 2005).  The Joint Commission Hospital Patient Safety Goal 7A focuses on preventing the transmission of infections, with hand hygiene as the key intervention.

Despite these guidelines and recommendations, nationwide, hand hygiene compliance is estimated to be below 50%.  Factors influencing poor compliance include a lack of knowledge, a lack of understanding of good practice and techniques, insufficient time, conflicting priorities, poor access to hand washing facilities, healthcare worker acquired contact dermatitis from frequent hand washing, and a lack of institutional commitment to good hand hygiene.

BH entities have been focused on increasing and sustaining rates of hand hygiene and have put the following elements in place: 

• long-term commitment of all stakeholders, from the Board of Trustees to the bedside staff
• multidisciplinary teams dedicated to improving compliance
• compliance monitoring and dissemination of data
• strategies to motivate and create personal accountability

Highlights

Baystate Health 

• Developed an organizational “culture of expectation”; this culture created an environment that empowers staff to make hand hygiene the expectation.
• Established a system-wide Hand Hygiene Task force which implemented a sustained, comprehensive, multi-modal, multi-disciplinary Hand Hygiene Program at each BH entity.
• Perform ongoing assessment of barriers to hand hygiene performance to influence practice.
• Identified unit and area-specific hand-hygiene champions, offering ongoing education and role playing exercises to facilitate "real time" feedback to healthcare workers.
• Provides ongoing staff education.
• Identified unit nursing and physician champions.
• Adopted use of alcohol-based hand rub and alcohol hand wipes that are easily and readily accessible.
• Adopted use of performance indicators.
• Hand hygiene champions placed posters in patient care areas encouraging patients to hold staff accountable for performing hand hygiene.
• Computer screen savers remind healthcare staff about hand hygiene and reinforce compliance.
• Healthcare worker type compliance data has provided additional information for targeted feedback to identified groups.

Future Work

The new focus for FY 2013 is hand hygiene "behind the curtain" or at the point of care, supporting healthcare workers, patients and their visitors in performing hand hygiene where it matters most, where care is provided.

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