Improving Hand Washing Compliance

Direct observation, education and creative signage are some of the initiatives hospitals are adopting in their attempts to improve hand washing compliance among staff. Fortunately for many, their efforts are paying off. Environmental services departments are seeing an upswing in hand hygiene compliance rates, as well as a positive attitude from staff members whose hand hygiene habits are under surveillance.

For this article, Facility Cleaning Decisions interviewed five hospitals to determine their methods for monitoring hand washing habits — and to find out what works and what doesn’t.

A Watchful Eye

Monitoring or observing staff directly is common practice in many hospitals. On a monthly basis, staff hand washing or sanitizing habits are monitored discreetly and randomly in patient rooms to verify if they are following hand hygiene protocol.

At Belton Regional Medical Center in Belton, Missouri, hand washing compliance rates for July 2014 were at 97 percent. According to Marvin Ellsworth, manager of environmental services, a select group of employees are monitored on a monthly basis, and if someone is non-compliant, personnel take immediate action.

“We approach them directly, explain what we’ve been doing and what we observe, then outline what they should be doing in terms of hand hygiene,” he says.

This information is shared with the infection control practitioner, who then follows up with the department directly.

In addition to approaching staff members at once, environmental services personnel typically follow up with some form of education to review hand washing procedures. At Geisinger Health System, Danville, Pennsylvania, non-compliant staff members are assigned an online course in hand washing.

“If someone is observed not properly following hand washing protocol when they walk in and out of a patient room, they will be assigned a remedial online course,” notes Jack VanReeth, director of environmental services. “That generates an electronic paper trail, and if someone is caught a number of times after having taken the course, it could result in progressive disciplinary action.”

Environmental services managers, like VanReeth, do not take hand washing compliance lightly. In addition to undergoing disciplinary action, repeat offenders could face termination. At Blanchard Valley Hospital in Findlay, Ohio, supervisory personnel are required to perform a minimum of 10 hand hygiene observations a month.

“If someone is non-compliant, the first opportunity is to educate one-on-one,” says Colleen Abrams, infection preventionist. “If they’re non-compliant a second time, the manager has to talk to them, and that could lead to disciplinary action. If it happens a third time, they would meet with me, and we would watch a Centers for Disease Control and Prevention (CDC) video together.”

Although Blanchard Valley Hospital has not had to let anyone go for hand hygiene non-compliance, Abrams says they could.

“Our human resources policy is written in such a way that if they don’t follow policy, it could result in termination,” she says.

While monitoring staff is typically the domain of supervisors and managers, some hospitals are improving compliance rates by relying on patients to monitor staff — or staff to monitor themselves.

For the second year, Blanchard Valley Hospital has included a question on its patient satisfaction survey form, asking whether or not the patient’s healthcare worker performed hand hygiene.

“Our scores have gone up 10 points in a year and a half, so we are seeing progress there,” notes Abrams.

Loie Couch, infection prevention specialist at Barnes-Jewish Hospital in St. Louis, has also seen improvement in hand washing compliance rates in the hospital intensive care unit (ICU).

“The manager at one of our ICUs decided that [hand washing] was a priority and empowered the staff to hold each other accountable,” she says. “So if I see you coming out of a room and you’ve missed a hand hygiene opportunity, it’s okay for me to say something. It’s about changing the mind-set of the staff.”