Dr. Andreas Glöckner has been employed by OPHARDT hygiene as Medical Director since August 2017. Thanks to more than 25 years of experience as a specialist for Internal Medicine and as an infection and intensive care specialist he knows all too well the typical challenges of hand hygiene in daily medical life.
In a personal interview he reports on why targeted hand disinfection among employees often fails and describes sustainable solutions to improve compliance, furthermore he explains the role that intelligent dispensers and monitoring systems can play in this context.
Markus Marek: Hand hygiene is the most important measure to prevent infections. In practice it is often neglected. Why does this happen in your opinion?
Dr. Andreas Glöckner: Although hand disinfection is the simplest, most effective and economic measure available to us to prevent infections and the distribution of multi- resistant pathogens it is not always practiced as required in daily clinical life. Studies have shown that hand hygiene compliance on hospital wards is often below 50%. This problem can be attributed to various aspects. It begins with inadequate knowledge concerning the indications for hygienic hand disinfection according to the WHO 5 Moment Recommendations and continues with a lack of adherence to these recommendations resulting in bad hand hygiene. Staff shortages and heavy work loads fuel this negative result, particularly among nursing staff who account for over 80% of all hand hygiene activities within a hospital. Seminars offered to support compliance are too infrequent and lack quality and there is no information provided on the number of nosocomial infections caused by poor hand hygiene. Last but not least there is a lack of hand disinfection dispensers and those dispensers available are not always in the right location and do not fulfil KRINKO recommendations.
Markus Marek: How can hand hygiene be improved in practice?
Dr. Andreas Glöckner: I could simply say – by omitting the problems that I have just mentioned. But that would be too easy and certain problems such as the nursing crisis and the lack of hygiene specialists in German hospitals will not be solved in the near future. This is the exact reason that makes the optimisation of work processes, adequate dispensers and their location and the installation of technical support systems, such as OPHARDTs hygiene monitoring system a practicable solution. Both patients and hospitals benefit from an improvement in hand hygiene. Indeed scientific data shows that an improvement in hand hygiene compliance reduces the number of nosocomial infections. A scientific research programme showed that a 10% improvement in hand hygiene compliance led to a reduction in the rate of nosocomial infections by 6,5%. In practice that means for any patient: the shorter the time spent in hospital the less likely they are to contract a life threatening sepsis. The hospital benefits from an improvement in treatment quality and cost savings.
Markus Marek: You just mentioned hygiene monitoring systems. Electronic measurement instruments are establishing themselves in hospitals. What benefits do such systems offer in the improvement of hand hygiene compliance?
Dr. Andreas Glöckner: Hygiene monitoring systems provide reliable information over a period of 24 hours, 365 days per year by recording data of hand disinfections – integrated software supports hospitals in the analysis of this data. The detailed information, including the number of hand hygiene activities and the amount of fluid withdrawn can be used to initiate training courses wherever needed. They can also be used to calculate compliance and are more reliable than the observation method that is affected by the Hawthorne-Effect. Various studies have shown that the Hawthorne Effect leads to increased compliance levels. In figures this means that the direct observation method results in a compliance rate of 75% but the compliance rate drops to between 25 to 40% when no observation is carried out. A relatively acceptable situation can suddenly change and become unacceptable. With little effort changes in hand hygiene can be detected quickly, and negative changes can be corrected equally as quickly.
Markus Marek: You have had your own first hand experience with an electronic monitoring system, in fact with the OPHARDT Hygiene Monitoring System, or OHMS, on an Intermediate Care Station at the BDH-Hospital in Greifswald. What did you investigate exactly and what were the results?
Dr. Andreas Glöckner: We analysed the effect that the use of the OHMS had on hand hygiene behaviour, the number of nosocomial infections and the use of antibiotics on the ward. The first stage, or the passive stage, was a period of 6 months (May 2013 – October 2013) where we observed hand hygiene behaviour, the frequency of nosocomial infections and the use of antibiotics. During the second 6 month period, the active stage (November 2013 – April 2014), targeted training sessions were held based on the collected data and the effect that these training sessions had were observed and analysed. Nosocomial infections and the use of antibiotics were registered from the first phase.
Special attention was placed on the analysis of how much hand disinfection fluid in total and on how much fluid per individual hand disinfection was used. These key figures are relevant because thorough and correct hand disinfection is only guaranteed when sufficient fluid is used (3ml).
The results from the research over the period of one year surprised me and at the same time convinced me about the positive effects of OHMS. In comparison to the previous year we saw a 30% increase in the consumption of hand disinfection fluid per patient day. The quality of hand hygiene improved as well. Thanks to targeted training measures based on the data obtained from the OHMS we were able to double the number of „correct“ hand disinfections (2 doses of fluid = 3,0 ml). Positive results were also achieved with the number of nosocomial infections seeing a reduction of 28% and the number of antibiotic treatment days reduced by 26%.
Markus Marek: Finally a look to the future: Where do you see hand hygiene in the next five years?
Dr. Andreas Glöckner: The increase in multi-resistant pathogens as a direct result of inadequate antibiotic use and poor hand hygiene are clearly a challenge for the future. Improvements to existing problems are very difficult for hospitals when faced with staff shortages and a lack of resources. However, a step in the right direction is the integration of data concerning hand hygiene behaviour in hospital Quality Assessment reports – this leads to an increase in pressure to improve hand hygiene. We need to provide hospitals with tools that automatically support and provide information on hand hygiene. I have already talked about the opportunities and benefits offered by a hygiene monitoring system.
An integral part of OHMS is a feedback monitor which was developed and introduced to ensure that electronically collected data is effective and to reduce workload. The use of this monitor on any hospital ward ensures that nursing staff are informed automatically and permanently about the status quo of hand hygiene directly at the point of care. Employees are informed about hand hygiene compliance and the trend of the previous weeks. The traffic light colours on the monitor indicate hand hygiene compliance and are updated throughout the day offering a kind of „automatic intervention“ that relieves strain on employees and resources. If shortfalls to target compliance levels occur the hospital ward and hygiene team are informed immediately and they can solve problems and intervene to ensure hand hygiene compliance is reinstated.
Markus Marek: Many thanks for taking time to talk to me!