Wednesday, December 15, 2010

Hand washing compliance: real quality or just another performance metric?

First a disclaimer. I am a strong proponent of hand hygiene. I strive to be 100% compliant where I work. But the skeptical side of me sees flaws in the hand hygiene dogma. Tracking hand cleaning rates as a performance metric (not a JC or CMS measure yet but being done at many institutions) may have unintended consequences. Moreover, the claim that hand washing keeps hospitalized patients safe from infections is simply not true. Allow me to explain. But first watch this video on hand hygiene at Vanderbilt, a leader in quality and safety.

It's clear the folks at Vanderbilt are passionate about hand hygiene but how effective is the measure, really? Watch the video closely and keep in mind evidence cited by the CDC in its guidelines that a 15 second hand wash is needed, as well as evidence that pathogens can be transmitted via the stethoscope. The stethoscope, perhaps more than the hands, is a major point of physical contact with the patient.

None of the people seen on this video cleaned their stethoscopes. And while it was difficult to tell how long they took to wash their hands it appeared to be well under 15 seconds in most instances.

Making the rate of hand washing the sole metric (91% at Vandy as reported in this video) may distract attention from equally or more important measures such as the length of the hand washing activity and the rate of stethoscope cleaning.

No comments: