Hand hygiene is an incremental component that protects patients and healthcare workers from healthcare associated infections (HAIs). Dr Didier Pittet, professor of medicine, director of the Infection Control Department at the University of Geneva Hospitals in Geneva and the director of the WHO First Global Patient Safety Challenge: “Clean Care is Safer Care” , along with some of his colleagues, recognized hand hygiene as a growing problem in the healthcare industry worldwide in reference to high mortality rates and an increase in costs due to HAIs. According to Dr. D. Pittet, “healthcare workers practice hand hygiene less than half as often as they should.”
Together, the team came up with a list of critical moments of vulnerability during an interaction between a patient and a healthcare worker. Dr. Pittet and his team named these moments, “My five moments for hand hygiene.” The study focused on 2 zones, the patient zone and the healthcare zone, and the critical sites found within these zones. The team chose to separate these points into zones in an effort to geographically represent the critical points of contact in which hand hygiene is required.
The patient zone is noted as the area in which the patient has contact with his/her surrounding surfaces. There are two critical sites within the patient zone, clean sites and body fluid sites. Clean sites are the sites that must be protected from micro-organisms at all times. Body fluid sites are the areas were patient fluids are exposed. As noted in the study, clean sites and body fluid sites can co-exist, example: drawing a blood sample.
The healthcare zone is the area outside the patient zone. Theoretically, this zone is constantly contaminated with micro-organisms that can potentially be dangerous to the patient and/or healthcare worker.
Below is a list of the five critical moments resulting from the study:
1)Before touching a patient… (example : shaking hands)
Can using a checklist help prevent infections and even deaths? According to Dr. Atul Gawande, author of, “The Checklist Manifesto: How to get things right,” implementing a checklist in healthcare for undertakings as large as surgery can help prevent healthcare acquired infections (HAIs) and therefore reduce the number of patients admitted to the Intensive Care Unit (ICU) because of infections and even prevent deaths. According to the Center for Disease Control and Prevention (CDC), HAIs account for about 1.7 million infections and 99,000 deaths each year and annual costs to U.S. hospitals (adjusted for inflation) range from $28.4 -$33.8 billion to $35.7-$45 billion.
A recent New York Times article appropriately titled, “A hospital how-to guide that mother would love,” gives great background on how Dr. Gawande’s book came to be.Dr. Peter Pronovost, a critical care specialist at Johns Hopkins medical center in Baltimore borrowed the concept of using a checklist from the aviation industry. He began by first having physicians use it for inserting central lines to prevent subsequent infections and after discovering its great success, applied the same concept to other situations in the ICU, achieving similar results.
Following Dr. Pronovost’s lead, Dr. Gawande launched his own study along with a team of public health experts and surgeons and applied a very similar 19-point checklist to test whetherit would improve surgical care. The eight hospitals involved in the study saw the rate of major postsurgical complications drop by 36 percent in the six months after the checklist was introduced; deaths fell by 47 percent.
While the results obtained in Dr. Gawande’s study are impressive and prove a very critical point, is the traditional checklist too fundamental? With cutting edge technology at our fingertips, that can go above and beyond reminding healthcare providers of steps to take when administering care, why stop at the checklist?
Healthcare providers work in incredibly fast paced environments and missing vital steps, such as washing their hands, can lead to HAIs and even deaths. RFID can be viewed as the evolution of a checklist and embraced by the healthcare community as a ‘next generation’ best practice.For example, the Dynamic hand-hygiene solution serves as an advanced form of a checklist, reminding care givers to wash their hands by not only tracking that they in fact did, but administering an audible signal if they fail to do so before approaching a patient. In addition, RFID applications for patient identification, error reduction at point of care, medications management, and asset and employee tracking ‘check the box’ with every move a provider, patient or asset makes. And, in addition to utilizing RFID as a means to more precise healthcare ‘to do’ management, the RFID is driven by a chain of data conversion events – each one a checkbox in and of itself – resulting in more intelligent and actionable information than a static checklist allows. If Dr. Gawande’s implementation of a checklist helped prevent so many HAIs and save so many lives, imagine what an RFID-enhanced checklist could do!
One of the themes evolving from conversations at IHI was how behaviors can be changed in a hospital. The fast-paced, sometimes hectic environment opens countless opportunities for error. According to an IHI demonstration presented at the conference, up to 30 percent of the time, a critical step is missed, wrong or inconsistent when delivering patient care.
At this year’s conference, Versus Technology, Inc., a real-time locating system (RTLS) vendor working closely with Dynamic, demonstrated its Hand Hygiene Compliance solution.Because small changes can add up to big results, multiple disciplines can be adopted by healthcare providers to meet the 10 percent reduction in costs they are aiming for. By 2015, it is Versus’s mission to save the healthcare industry a billion dollars. With 10 percent of the nation’s hospitals using Versus’s locating technology, they believe they can achieve this number with its Hand Hygiene Compliance solution alone.
“This year, compared to years past, we definitely noticed a higher level of interest from attendees in solutions like our Hand Hygiene Compliance solution,” said Henry Tenarvitz, Chief Intellectual PropertyOfficer of Versus Technology, Inc. “Healthcare providers know that reforming the healthcare industry is a huge undertaking, but integrating technology that will help them be more cost effective, safer and more efficient is how we can improve patient care right now.”
Experts estimate that compliance with recommended hand-washing protocols would prevent more than 50 percent of HAIs, but hospitals lack the necessary resources and technology to accurately monitor hand-washing compliance. In fact, current methods—short-term “Secret Shopper” surveys or costly observation audits—manage to skew compliance rates while only capturing 0.12 percent of all hand-washing opportunities. With the Versus Hand Hygiene Compliance solution, hospitals are now able to continuously collect data that was previously unavailable or unreliable. Monitoring hand washing in real-time helps hospitals prevent the spread of dangerous infections and the cost of non-reimbursable HAIs.
For after-the-fact discovery, the Hand Hygiene Report helps Infection Control and Patient Safety Managers direct additional education and training to areas where compliance rates are not in-line with patient care episodes. Advanced users will actually prevent non-compliant patient care events by alerting caregivers to their compliance state before attempting patient care. With this Hand Hygiene Compliance solution, hospitals have a reliable method to reduce their potential for costly Hospital-Acquired Infections (HAIs).
“Unlike banking or other industries that went through a necessary process of automation, one of the unique challenges the healthcare industry faces when exploring efficiencies is that healthcare simply cannot be replaced with technology,” added Tenarvitz. “We have to be able to integrate the technology with the people providing the care. RTLS can help automate the delivery of healthcare through the staff using the technology and increase efficiency.”
Last week more than 5,000 leaders from across the country joined the Institute for Healthcare Improvement (IHI) for its 21st Annual National Forum on Quality Improvement in Health Carein Orlando, FL.According to an article published in HealthLeaders Media, IHI President and CEO Don Berwick began the conference observing how many healthcare organizations have made vast improvements in addressing some of healthcare’s largest challenges, including patient centered care, patient safety and chronic disease-care innovations. According to Berwick, with current reform efforts in Washington—carrying an estimated 10-year, $1 trillion price tag—a debate about how to balance two fundamental options, investing scarce resources in improving quality-of-care or simply doing less for patients, has surfaced.Berwick’s stance is one we can all stand behind — neither of these options to the extreme are sustainable solutions for the current generation or future generations, he said.
While our elected leaders continue drawing battle lines around out what “reform” looks like, healthcare providers can take action now to lower their cost of providing care. Berwick suggested some ideas to get started:
Understand your “healthcare commons”—its limits and boundaries, who uses its resources, and who is served.
Adopt a goal—such as over the next three years, reduce total resource consumption of your healthcare system by 10 percent. This could be achieved without rationing or exclusion of needed services.
Develop your strategic technology plan fast—”because there isn’t much time left,” he said. “Do not wait for external rules to be made or to change. Do it yourself.”
As healthcare providers look to technology to improve operations, at IHI there was an obvious shift toward adopting pragmatic, patient-centered solutions. Providers are looking to implement technology solutions that directly address key performance indicators (KPIs) and tie in with the implementation of Electronic Health-Records (EHRs). Behind every decision, healthcare providers are trying to figure out if the technology falls under the still undefined definition of “meaningful use.” At one time it was said the federal definition and criteria for the “meaningful use” of EHR systems would be released by mid-December, but that deadline passed today at noon with the next deadline being December 31, 2009. With more than 2 million patients developing HAIs each year, costing the healthcare industry more than $30 billion in preventable health costs, one of the best place to start implementing cost saving solutions is where HAIs can be prevented.
“Studies suggest that only 50 percent of caregivers actually wash their hands when they’re supposed to before patient contact, although 90 percent think they do it when they should.”
According to an article posted on HealthLeaders Media byCheryl Clark, a CDC video is now being shown to hospitalized patients and visitors urging them to insist they witness providers washing their hands by the bedside, even if the doctor or nurse says he or she already washed just before entering the room. The five-minute video portrays a patient asking her doctor to wash his hands before being examined to reduce the risk of acquiring infection. According to the Center for Disease Control and Prevention (CDC) Healthcare-Acquired Infections are a top 10 leading cause of death in America — killing about 100,000 people a year and infecting about 2 million. One of the simplest ways HAIs (Healthcare Acquired Infections) can be prevented is by medical personnel properly washing their hands.
A before-and-after survey conducted by Premier Inc. Healthcare Alliance showed that after patients watched the video, twice as many were willing to ask their doctors or nurses to perform hand hygiene than before the video was provided. Nearly 1,000 nurses and 611 physicians were also shown the video at points in time both before and after the video was widely shown throughout the hospital. Both doctors and nurses said they were much more likely to get reminded by patients about washing after the video was shown.
According to the article, HAIs are estimated to affect more than 1.7 million patients, kill 99,000 patients, and cost between $35 billion and $45 billion annually. And, under the new federal reimbursement policy, payment for care required as a result of hospital acquired infections will no longer be approved, making prevention quite influential on the bottom line.
While the survey results show the video is effective in helping patients be more comfortable in confronting their healthcare providers and taking an active role in ensuring they are washing their hands, the question we should be asking is: Should it be the patients responsibility to ensure medical personnel wash their hands or can the healthcare provider implement a solution? Physicians and nurses work in incredibly fast paced environments and, as an industry, the more that can be done to help them, such as technology backed “reminders” to wash their hands, the more we can help ensure patient safety.
Dynamic Computer Corporation (DCC) is piloting a cutting-edge sensor-based hand hygiene compliance solution to prevent healthcare-associated infections (HAIs) at the University of Miami Center for Patient Safety. HAIs are among the top ten causes of death in the US.
FARMINGTON HILLS, Mich. July 29, 2009 — The University of Miami UM-JMH Center for Patient Safety has successfully launched a hand hygiene compliance (HHC) pilot project with the help of two Michigan-based technology businesses who specialize in health care real-time locating solutions (RTLS).
Dynamic Computer Corporation is a health care RTLS systems integrator based in Farmington Hills, Mich. Traverse City -based Versus Technology designed the automatic HHC system using their patented infrared – radio frequency (IR-RF) technology that has been deployed in hundreds of hospitals for automating patient workflow events. The HHC solution can be deployed as a standalone system or as part of an enterprise RTLS system.
How the HHC solution works
The solution uses small IR-RF sensors in soap dispensing units that read staff ID badges and monitor the location and timing of hand-washing events. Employees hear a verification sound upon successful information capture about whom, when and where the hand washing event has occurred.
“Nothing matters more than the safety of our patients. That’s why we are working with Versus and DCC to create an exciting, technologically-advanced system to decrease healthcare-associated infections,” said David J. Birnbach, M.D., M.P.H., Director, UM-JMH Center for Patient Safety.
The goal of the HHC solution is to prevent healthcare-associated infections (HAIs) by promoting evidence-based practices and fostering a culture of safety and accountability. Hospitals are able to accurately track and report on HHC compliance in real time, and retroactively to monitor problem areas for additional training where necessary. Staff members are alerted in real time when they forget to wash their hands, before an adverse event takes place.
“This is a reliable and affordable solution with compound benefits for hospitals seeking to improve patient care and processes while greatly reducing costs,” said Farida Ali, DCC President & CEO. “This is just one example of how innovative technologies are transforming the way we deliver care. Everyone is a stakeholder.”
Henry Tenarvitz, Chief Intellectual Property Officer of Versus agrees, “It is very important to Versus Technology that we provide solutions that not only reduce the potential for hospital acquired infections, but do so in a way that increases hospital staff efficiency.” Tenarvitz continued, “Our commitment to making compliance systems affordable has driven Versus to discover ways to leverage existing nurse call infrastructure to control installation costs.”
The UM-JMH Center for Patient Safety is planning to use the system to train students, resident physicians and nurses, and to advance their mission of preventing medical errors and improving patient safety.
“The expertise of these partners is the ideal complement for our mission, and together we can create a culture of patient safety,” said Dr. Birnbach.
How big is the HAI problem?
“Americans don’t expect to get additional infections when they go into the hospital. Stopping health care associated infections and improving the quality of care is one of our top priorities,” stated HHS Secretary Kathleen Sebelius in an press release earlier this month.
According to the CDC, HAIs account for about 1.7 million infections and 99,000 deaths each year. Most of these are preventable by proper hand washing. Here are a few facts from the CDC’s March 2009 report on the direct medical costs of HAIs.
There are about 4.5 HAIs for every 100 hospital admissions
Direct annual costs to US hospitals (adjusted for inflation) range from $28.4-$33.8 billion to $35.7 - $45 billion.
Anywhere from about 20-70 percent of HAIs are preventable, equaling a saving s of $5.6- $6.8 billion to $25-31.5 billion to the healthcare system with effective prevention measures.
“HAIs in hospitals are a significant cause of morbidity and mortality in the United States” (Health Public Reports, 2007).
For more information on RF-integrated HHC solutions, contact Dynamic at www.DynamicRFIDSolutions.com/contact or call toll free 866-257-2111.
