Healthcare workers want electronic feedback to improve hand hygiene in their workplaces, but they want this feedback to be tracked on a group level, not individually. These findings, recently published in the Journal of Hospital Infection, highlight that a lack of hand hygiene feedback from their organizations is a key problem that healthcare workers face.
As the authors of this study note, “hand hygiene…is considered the single most important measure to reduce [hospital-acquired infections.]”1 The status quo causes harm and even death. According to the CDC, 1 in 31 hospital patients in America have a hospital-acquired infection on any given day – leading to 687,000 hospital-acquired infections and 72,000 deaths over the course of a year.2
How can we change this status quo? Some solutions are uncomplicated, like investing in training and placing hand hygiene dispensers at the point of care, but we are only just beginning to understand what it will take to do the work of encouraging behavioural change across organizations. These researchers at the University of Uppsala in Sweden observe that “there is a paucity of studies addressing individuals’ perceptions of having such a system and how the organization works.”3
Workers want feedback—but not individual tracking
Many participants in the study said that they rarely or never receive feedback from supervisors or hygiene specialists in their organization. “No, I can’t remember any time in the last year that we have received feedback on hand hygiene,” a physician noted.4
Participants held mostly favourable opinions about implementing an electronic reminder system, but there was wide opposition to a system that tracked individual performance. Healthcare workers feared personal infringement and reprisals.5 However, they had no objections to hand hygiene behaviour tracking at the group-level.
Solving the problems of hospital-acquired infections requires understanding the issues of power dynamics within healthcare institutions. Creating a collective sense of ownership within teams and wards is key to improving hand hygiene, and the electronic reminder system needs to aid that goal, not hinder it.
Power dynamics and hand hygiene
What feedback healthcare professions did receive, was often given by their peers.6 When participants were asked whether they give feedback, they said they did, but mostly to peers or students. Nurses were less likely to give feedback to physicians. These findings are also supported by another recent study in Antimicrobial Resistance & Infection Control, which explores the role of shared ownership and team hierarchy in determining the success of infection control practices during surgeries. This study claims that “the sense of ownership over [surgical site infection] occurrence was closely tied to how preventable staff perceived infections to be.”7
Participants in this study reported that it could be difficult to give hand hygiene feedback to staff they perceive to be superior to them. One scrub nurse admitted, “… sometimes I just prefer not to say anything, I know it’s not right, but I just prefer to not say anything … I will get nervous, because … we say that they have the knife, they have the power.”8
When we start looking at changing systems, we need to reckon with the unhealth in the existing system. Implementing individual tracking is met with resistance because of a lack of consistent feedback from leadership.
When asked what resources are needed to make feedback more sustainable, they suggested “utilising electronic records for easier data capture.”9 Good data, on both hand hygiene and clinical outcomes, was seen as vital to improving infection control.
Electronic feedback systems need to help increase feedback without a fear of reprisals and it needs to help foster the type of team dynamics that lead to a strong sense of shared ownership.
Better privacy and better results
These studies confirm what we have long believed at OPHARDT. As a pioneer of electronic hand hygiene feedback for healthcare institutions, OPHARDT has chosen group-based feedback from day one. Ever since the OPHARDT Hygiene Monitoring System (new name Kanary) launched a decade ago, we have never introduced individual tracking.
We believe that motivating a group through a strong sense of collective ownership is key to improving results. We also believe that preserving individual privacy is key to getting people excited about implementing electronic tracking. Digital feedback can either be seen as a tool of coercion or a helpful source of reliable data, depending on how it is rolled out. We do not force employees to wear special electronic badges, instead OHMS tracks dispenser use. Responding to healthcare workers main objection to adopting an electronic feedback systems is key to the system’s success.
When we decided that OHMS would track group behaviour, these types of studies had not yet been published. We made this choice not just because we believed that it was the most effective solution, but because it was the right thing to do. Privacy is baked into OHMS.
As more studies are published about healthcare workers attitudes towards electronic feedback and the social dynamics of healthcare institutions, we hope that it helps organizations provide the type of feedback that has the maximum buy-in and greatest potential for infection prevention.
1 Blomgren, P.-O., et al. “Healthcare Workers’ Perceptions and Acceptance of an Electronic Reminder System for Hand Hygiene.” Journal of Hospital Infection, vol. 108, Feb. 2021, pp. 197–204, 10.1016/j.jhin.2020.12.005, p. 197.
2 Data Portal. 2020, www.cdc.gov/hai/data/portal/index.html.
3 Blomgren, P.-O., et al., p. 197.
4 Blomgren, P.-O., et al., p. 200.
5 Blomgren, P.-O., et al., p. 201.
6 Blomgren, P.-O., et al., p. 200.
7 Troughton, Rachael, et al. “Understanding Determinants of Infection Control Practices in Surgery: The Role of Shared Ownership and Team Hierarchy.” Antimicrobial Resistance & Infection Control, vol. 8, no. 1, 15 July 2019, 10.1186/s13756-019-0565-8,
8 Troughton, Rachael, et al.
9 Troughton, Rachael, et al.