We continue to generally do a poor job of improving compliance with recommended hand hygiene standards (see our Patient Safety Tips of the Week for January 5, 2010 “How’s Your Hand Hygiene?” and May 24, 2011 “Hand Hygiene Resources”).
Now a new study (Armellino 2012) has shown the video monitoring with feedback can dramatically improve compliance with hand hygiene practices in a sustainable way. The study was conducted in an ICU setting. Cameras were placed to view all sinks and hand sanitizer dispensers and were activated by sensors that detected people entering or exiting rooms. Performance feedback was continuously displayed on electronic boards mounted within the hallways, and summary reports were delivered to supervisors by electronic mail.
In the period prior to providing feedback the compliance rate with hand hygiene was less than 10%. After feedback began compliance rates improved to over 81% at 16 weeks. By 75 weeks compliance was at an astonishing 87.9%!
What we don’t yet have are details of any impact this intervention has had on infection rates and a cost-effectiveness analysis. Some prior studies that demonstrated improvements in hand hygiene compliance did not always show improvement in infections rates. In a previous study (Rupp 2008) the introduction of alcohol-based gel resulted in a significant and sustained improvement in adherence to hand hygiene but did not result in reduction of the incidence of healthcare-associated infection. So keep in mind that the hand hygiene rates are a surrogate measure. The actual outcome measure of importance is the hospital-acquired infection rate.
We can think of a number of other areas in which video surveillance with feedback has the potential to significantly improve compliance with recommended practices. We’ve previously mentioned that the timeout in the OR is one especially in need of improvement and could benefit from video recording with feedback done in a constructive fashion.
Armellino D, Hussain E, Schilling ME, et al. Using High-Technology to Enforce Low-Technology Safety Measures: The Use of Third-party Remote Video Auditing and Real-time Feedback in Healthcare. Clin Infect Dis. (2012) 54 (1): 1-7 First published online: November 21, 2011
Rupp ME, Fitzgerald T, Puumala S, et al. Prospective, Controlled, Cross-Over Trial of Alcohol-Based Hand Gel in Critical Care Units. Infect Control Hosp Epidemiol 2008; 29: 8–15