by Malpractice handwashing is on the horizon
This little-known “Readily Available” legal principle awakens Risk Management interest in electronically verified handwashing. Here Russel Nassof, founder of RiskNomics explains:
Immersion into the topic of hand hygiene to reduce operational risk continues to fill industry meeting agendas. The suspicions of the past have now been confirmed by so many respected authorities. Electronically acquired data can and does change hand hygiene behaviors in a positive and sustainable way.
It is estimated by APIC that only 3-5% of hospitals are currently taking advantage of electronic handwash monitoring. In nursing homes, where 380,000 residents die annually from a facility-acquired infection, it is virtually nonexistent. The dominant reason of cost is being blown out of the water when comparing the technology investment to savings available via verified reductions in HAIs.
Handwashing For Life Healthcare interprets this low penetration to be a function of five factors:
- Unit and charge nurse lack of conviction of lowered HAI rates, blocking C-Suite’s assessment of risk.
- Having a number does not change behaviors.
- Quality Assurance, Patient Protection, and Infection Prevention are respected for their technical knowledge and passion but are less effective in convincing Operations and Risk Management to install an electronic solution.
- Keeping up with the flood of regulations consumes key resources.
- Inability to monetize the risk factor of the unwashed hand within the budget year.
The intense focus on hand hygiene in the patient room has left the kitchen largely outside the net of current monitoring systems. The kitchen is not seen as a major source of healthcare infections yet In a study published in AJIC (American Journal of Infection Control) norovirus, frequently associated with food preparation, was identified as the pathogen most often responsible for shutdown/closure of a hospital unit/department.
The popular World Health’s 5 Moments for Hand Hygiene standard ignores the kitchen as a source. Infection Preventionists are content that the common practice of “Wash In. Wash Out” using hand sanitizer has improved compliance rates and provides a framework to track compliance in patient rooms. The intent of the 5 Moments is often replaced by the reality of 2 Moments – in and out.
Moral issues emerge as data exposes reality. How could an operation be serious about a path of continuous improvement without a baseline founded on reality? Handwashing rates in healthcare kitchens and patient areas appear to both be hovering around 30%, 40% max. The FDA Food Code is apparently being meet sufficiently by culinary as their permits are regularly renewed The Joint Commission audits are known for their rigor but yet approve the operations with 30% compliance, urging them to report reality rather than the 90% commonly proclaimed.
