A recent survey of more than 1,000 doctors and nurses shows The direct observation to record hand hygiene compliance is viewed critically. In return, hospital staff see electronic measuring instruments as a forward-looking technology.
Almost every hygiene specialist knows it: The recording of hand hygiene behaviour on the ward by direct observation. With a pen and paper in their hands, hospital staff members’ hand disinfections, both those carried out and those not carried out, are recorded meticulously. The WHO model of the 5 moments of hand hygiene serves as basis for this. The collected observation data are then laboriously entered on the PC and thus digitized. It quickly becomes clear that this form of compliance measurement is a real time-eater and cannot really be called contemporary.
Hygiene management in hospitals is playing an increasingly key role, especially when we think of the trend in antibiotic resistance or consider the circumstances of the Covid 19 pandemic. It is therefore safe to say that the field of work of hygiene specialists is becoming more demanding and the time factor is becoming an increasingly important “good”.
Even today, direct observation is only carried out selectively in certain wards due to lack of time, which means that only small sections are available. In addition, the observation of the staff even falsifies the results obtained. The keyword at this point is the Hawthorne Effect. This means that there is really no complete picture.
The use of data from a hygiene professional’s perspective plays an important role in improving hand hygiene compliance and ultimately preventing nosocomial infections.
Clinical staff sceptical about direct observation
If we look at the situation through the eyes of the nursing staff and the medical profession, it becomes clear that they attach an extremely high importance to hand hygiene compliance. This is shown by a recent study published recently in the Journal of Hospital Infection and conducted at two hospitals in the UK.*
Direct observation seems unsuitable for determining real hand hygiene compliance and for determining the volume of disinfectant per hand disinfection. Electronic hand hygiene monitoring systems can, on the one hand, permanently reflect the hand hygiene performance and, on the other hand, sustainably improve the hygiene behaviour of hospital staff through direct, permanent feedback as a kind of auto-intervention. However, direct observation is indispensable for determining the indications, describing the hand hygiene quality (technique, exposure time) and personal feedback.Dr. med. Andreas Glöckner, Medical Director
As part of the scientific study, more than 1,000 doctors* and nurses* took part in a survey and also made specific comments on the direct observation described above. Their opinion: More than half of all respondents consider direct observation to be ineffective (40% in Hospital A and 44% in Hospital B). Reasons given by hospital staff were “does not reflect reality” or “no meaningful data”.
Rather, a large proportion (70% and 74%, respectively) of hospital staff see electronic monitoring systems as a promising approach to measuring hand hygiene compliance.
The signs point to digital hand hygiene
The results show that the medical staff is absolutely open to new ways of hand hygiene detection and that in most cases the hygiene professional does not have to fear broad resistance when it comes to the introduction of an electronic system and smart disinfectant dispensers.
The advantages that these innovative solutions explicitly offer for hospital hygiene can be summarised concisely:
- valid data on hand disinfectant consumption and hand hygiene behaviour
- comprehensive picture of the donor infrastructure and frequencies of use
- time saving through automatic and continuous 24/7 recording
- automatic notifications of critical levels
- more frequent feedback to hospital staff
Especially the latter point is becoming increasingly important and can have a lasting positive influence on hand hygiene compliance in hospitals. This is also shown by the British study, which addresses the need to communicate observed hand hygiene deficiencies directly to staff.
The ingo-man® SmartNose is a successful example of a technological innovation in this area. The intelligent dispenser is compatible with all common Euro dispensers of the ingo-man® plus series and informs the hospital staff via a green feedback LED as soon as enough disinfectant has been dispensed – fully automatically and absolutely resource-saving. In addition, the “smart nose” records every single activation and other important hygiene parameters, which can be called up via the corresponding software.
For example, within the framework of a comprehensive study by Dr. Andreas Glöckner at the BDH Clinic in Greifswald, hand disinfectant consumption per patient day was increased by 31% and nosocomial infections were reduced by 28% in the same period – based on the hand hygiene data of the OHMS.**
In conclusion, the current study from Great Britain shows once again that the time has come for electronic hand hygiene monitoring and can largely replace time-consuming direct observation.
* Cawthorne, K-R., and R. P. D. Cooke. “Healthcare workers’ attitudes to how hand hygiene performance is currently monitored and assessed.” Journal of Hospital Infection (2020).
**Glöckner A. Elektronisches Händehygiene Monitoring System: Auswirkungen auf Compliance und Infektionen; 9. Nationaler Qualitätskongress Gesundheit, Berlin, 03./04.12.2015