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Watch Your Hands: Digital Monitoring Helps UnityPoint Keep Tabs On Staff Hygiene

AP Photo / Rob Carr
A sign urging staff and patients to wash their hands hangs on the wall as a patient is wheeled through the emergency room at Greater Baltimore Medical Center.

Handwashing is front of mind for many during the pandemic. But washing often and thoroughly is always a goal in healthcare.

Hospitals monitor how workers do hand hygiene to limit the risk of spreading infections. How they choose to do that varies by healthcare system.

Like many, UnityPoint Health for years relied on simple observation. Supervisors would audit their employees to make sure they were lathering up soap or sanitizer in between encounters with new patients, spaces and equipment.

UnityPoint Infection Prevention Coordinator Jennifer Liberty said that model only gave a small glimpse at what was actually happening among care staff.

“From those manual observations that we’ve done for years and years, we know that we’ve only captured about 1% of all the hand hygiene opportunities," Liberty said. "The other thing with those manual observations is we know they’re typically inflated, because people know they’re being watched."

In other words, employees were on their cleanest behavior when they knew it was being documented. Allowing for that is the premise behind the electronic monitoring programs more hospitals are transitioning to.

UnityPoint implemented a system called SwipeSense at its Methodist and Proctor hospitals about three years ago. It just came to the Pekin campus in December.

All staff that interact with patients — from doctors and nurses to lab techs and dietary workers — wear a keycard that tracks them through the hospital.

As Liberty explains, that card gets scanned in each room.

"When I walk in the room, it says 'Jennifer Liberty was in this room on this day at this time.' And then from the time I walk in the room, I have one minute to either wash my hands or use the sanitizer," she said.

The same is true when staff leave the room. Both of those so-called hand hygiene opportunities are collected by SwipeSense and assigned a compliance score.

"If I’ve washed my hands going into the room and then again when I come out, my compliance score is 100%," Liberty said.

A report is generated for each employee every two weeks. But Liberty said they don't just look at the data on an individual level — they can look at the numbers for the hospital as a whole, a specific nursing unit, or even sort by job title.

Since January alone, Liberty said, SwipeSense has collected more than 2 million hand hygiene opportunities at UnityPoint hospitals.

She said that allows them to be strategic with efforts to prevent what's called hospital-associated infection — the spread of illness to people under care.

“Of course, those have much poorer outcomes for patients. They come with an extraordinary cost to the healthcare system," Liberty said. "We know from many studies over many years that most of those infections are spread on the hands of healthcare workers.”

According to data from the Centers for Disease Control and Prevention, about one in 31 patients acquires a hospital-associated infection in a given day and over 72,000 die of their infections each year.

Liberty said that's not lost on care staff. She said it's always healthcare workers' intention to follow proper hand hygiene protocol. But they're also human, and sometimes overestimate their hand-washing routine.

“In all three hospitals, when we first implemented the program, people tend to think they’re washing their hands 100% of the time," she said. "If you ask somebody, ‘how is your hand hygiene compliance?’ everybody says, ‘I wash my hands all the time.’ What we’ve found is that when we first implemented the system, it’s a shock. People think, ‘That can’t be right. I know I wash my hands more often.’”

When SwipeSense was introduced at UnityPoint - Pekin, for example, it showed staff were only washing their hands or using sanitizer around 60% of the times that they should.

Liberty said while that might sound shockingly low, it's actually among the highest initial compliance rates SwipeSense has seen.

"The healthcare systems that go live with an electronic monitoring system, the average is about 40%," she said.

Liberty said there's about a 9% margin of error built into the system. That's one of the reasons compliance is never expected to reach 100%. The other: reacting to the patient's needs in real time.

“If a patient is getting ready to fall or there’s another emergency going on in the room, that certainly needs to take precedent over stopping to perform hand hygiene," she said.

Still, Liberty said, compliance rates improve rapidly after staff see the numbers. She said compliance is even higher since mid-March, when COVID-19 became a major concern at healthcare facilities.

Liberty said SwipeSense is just one tool in making sure infections don't spread at UnityPoint hospitals. But there are clear signs it's helping.

“In the first 18 months of implementation at Methodist and Proctor, we had a 15% increase in compliance over that 18-month period, which coincided with a 12% decrease in our hospital-associated infections," Liberty said.

And she said the same success is expected at the Pekin campus over time.

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