According to the Centers for Disease Control and Prevention, an estimated 2 million patients acquire a hospital-related infection every year and 90,000 die from that infection. The Joint Commission’s newly created Center for Transforming Healthcare is using robust process improvement methods to find the root causes of, and solutions for, dangerous and potentially deadly breakdowns in patient care.

In December 2008, the Center’s first project, focusing on hand hygiene, was initiated. This project is designed to improve and sustain hand hygiene compliance in health care organizations. Hand hygiene is vitally important to providing safe, high quality patient care, and its importance has been overlooked for far too long. In many cases, hospital-acquired infections are transmitted inadvertently by health care personnel. That is why a comprehensive, systematic and sustainable change is the only viable solution to this problem.

Eight highly respected hospitals and health care systems, with experience in process improvement tools such as Lean Six Sigma and change management, worked to develop a sound measurement strategy to accurately measure hand hygiene compliance within their organizations. After extensive evaluation, these organizations were able to determine where hand hygiene compliance was highest, where it could be increased and how overall compliance might be improved. Remarkably, as a baseline metric, these eight hospitals found that staff washed their hands less than 50 percent of the time.

There are several reasons why hospital personnel might fail to sanitize their hands on a regular basis. The following are a few examples with possible solutions for improvement.

• Ineffective placement of dispensers or sinks
• Place numerous alcohol-based hand sanitizers at many locations to increase access
• Work environment does not stress hand hygiene at all levels
• Make washing hands a habit
• Facility should commit to achieve 90+ percent hand hygiene compliance
• Hold all staff (doctors, nurses, technicians, etc) accountable and responsible
• Hands are full
• Create an area so staff have a place to put down charts and other material while washing hands

One main purpose of the hand hygiene project is to educate hospital staff about ways they can improve their compliance and decrease the occurrence of hospital-acquired infections among patients. An acronym for overall solutions is H.A.N.D.S. which stands for:

• Habit – always wash when entering and leaving a patient care area, do it consistently
• Active Feedback – engage staff with immediate feedback, acknowledge improvement
• No One Excused – hold everyone accountable and responsible
• Data Driven – use trained, certified observers to monitor hand hygiene skills
• Systems – make it easy for staff to improve hand washing compliance

The Center’s work to identify and measure poor quality and unsafe health care will lead to the development and testing of targeted, long-lasting patient safety solutions. These proven and practical strategies, based on methods such as Lean Six Sigma long used by other industries, can help transform American health care into a high-reliability industry that ensures patients receive the safest, highest quality care they expect and deserve.

To learn more about the Joint Commission or the Hand Hygiene Project please visit our website.

(Jerod M. Loeb, PhD is Executive Vice President for Quality Measurement and Research at The Joint Commission and a member of the Water Quality & Health Council.)

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