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News archive - November 2013

Hand hygiene ‘merely a tick box exercise’

Hand hygiene ‘merely a tick box exercise’

Hospital managers are preventing infection control nurses from reporting poor hand hygiene compliance in order to keep ratings up, it has been claimed.

Annette Jeanes, director of infection prevention and control at University College London NHS Foundation Trust (UCLH), told the conference current audit procedures were fundamentally flawed, with some hospitals reporting 100% compliance when the reality was probably much lower.

Her comments come after she carried out an investigation into existing hand hygiene reporting and monitoring systems.

She said: “Around 25% of those carrying out the audits did not report low scores and instead redid the audit. Any reports of 85% compliance or less were routinely disregarded and in some cases staff were told they were being observed and were asked to change their behaviour in order to get a higher score.

“When we quizzed infection control nurses we were told that in some cases managers would not let them submit low data.”

Jeanes began to monitor hand hygiene on the wards at UCLH in 2005 when compliance was around 20%.

She revealed: “We trained staff to carry out audits and sent them out to collect data, with the trust setting a target of 85% compliance. Currently we are achieving 97% compliance and the trust is extremely happy with that.”

But, she claimed, these impressive figures were not backed up by her own experience of observing the wards.

She said: “These figures do not collate with what I am seeing, which is more like 24% compliance. I am speaking to patients who say their doctor did not wash their hands and their nurse did not wash their hands when changing their dressing.”

This led her to review current reporting and auditing processes, with staff describing it merely as a ‘tick box exercise’ and criticising infection control leads for ‘having nothing better to do than nitpick and tell tales’.

In addition, only 42% of those in charge of auditing had been given formal training and just 6% had that training updated regularly. And these members of staff were rarely given enough time to carry out the audits.

Jeanes said: “Traditionally hospitals have focused on collecting data and not on hand hygiene, and the data they collect is not particularly reliable or useful. We need some sort of reliable information focused on improvement and risk, not just hand hygiene opportunities. We need to provide training and support and we need to give staff time to monitor the situation properly. In future we have got to do much more than just observe.”

She added: “When we are collecting data it seems we are missing the point and that is that we should be focusing on infection prevention and control and preventing the transmission of micro-organisms. Currently the emphasis is too much on collecting data and too little on what we are actually trying to achieve.”

As a result she has drawn up a new auditing tool for UCLH that provides assurance and identifies areas for improvement.

“It is about putting hand hygiene into context and integrating it into all elements of hospital care,” she said.

“The system looks at key areas such as skin problems, glove usage, the environment, information, education etc and gives a weighted score. You can then see exactly where the problems and opportunities for improvement are and, once you get 100% in one area, you can review the process and include other areas that you may need to work on.

“We have got to demonstrate to patients and to our organisations that hand hygiene audits demonstrate value and to do that we need to focus on reducing risk and increasing opportunities for improvement. It has got to be less about achieving targets.”

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