Quality & Patient Safety

Measuring Your Hand Hygiene Culture?

Patient Safety Quality Monthly, February 28, 2011

Measuring Your Hand Hygiene Culture?
Hand hygiene or sanitizing is one of those areas that continue to be with us, but it is not an easy one to measure to see if we are making progress. Sure we can do direct observation to try and see what people do and some organizations are using dyes in soap etc so they can scan hands. While these direct data collection measures are useful (and a great way to encourage accountability), they don't really give us an easy to manage indicator of our overall Hand Hygiene culture – including staff, physicians and visitors.

So let's consider another approach. What if we attempted to estimate our hand hygiene culture through an indirect measure? When we design data systems we look for the easiest way to get us as close to a useful answer as possible. So for hand hygiene culture let's consider the indirect measure of "Volume of Hand Sanitizer Used". Every time an employee, physician, patient or visitor squirts a little of that foam or gel into their hands, they are indicating support of your hand hygiene culture.

We can probably feel quite comfortable drawing the correlation between volume of sanitizer used and the strength of our culture.  Keep it simple, we are not trying to correlate volume of sanitizer to infections – just to our culture of hand hygiene awareness and willingness to take some action.

Let's take it another step and expand that to add volume of hand soap used in the facility. Now if we combine these two volumes we will start to have a pretty good indication of the number of times that people do an effective job of hand hygiene. Sure, some people will wash their hands without soap, and yes some of the sanitizer spills on the floor or gets left in the container – but that will probably remain constant over time. So looking at the trend is a pretty solid indicator.

So how can you do this? Call up your supply management people and ask for the monthly numbers. They have to resupply and purchase new containers so they will probably have a pretty easy time of giving you a ball park number of containers used. Next we need to convert the containers used into "Uses" or "doses". This will vary depending on your product but the conversion is in the sales literature or just a quick web search.

Now we have a combination of doses of soap and sanitizer. How do we analyze this? Start with the whole facility and see if it is increasing. Use your standard data methods (Trends, crossing averages, control charts etc.) to monitor the long term trends – remember to smooth them out. Look for a continuous increase in the use of the products which would imply that more instances of hand hygiene are occurring which would imply that we have developed a stronger culture. I would suggest monthly usage data, but remember that there may be quite a lag.

After you have looked at the overall facility trend – with a 3–4 month rolling average, consider calculating the number of hand hygiene instances per person. Just estimate the employee hours, including physicians as well as visitor and patients and that will give you a rough indication of hand hygiene instances per person. Again, not perfect, but does it really have to be? Are you pleased with the number? If you doubled or tripled the number would you be pleased? Are you seeing a trend that is reassuring?

As always, our data is supposed to help us make good decisions, even rough estimates can be very useful.

If you have been doing this we would love to hear how it is working for you. Drop us a note and we will report back on what we are hearing. (KROHDE@greeley.com Sr. Consultant for Patient Safety and Process or TSWARTZ@HCPRO.com Editor of Briefings on Patient Safety)

Most Popular