VHA Hand Hygiene Information and Tools
Collected or Developed by the National Center for Patient Safety (NCPS)
of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA)
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Hand Hygiene Information and Tools FAQ
One frequent and important question asked is this: What data can be acquired, studied and returned to providers and other health care workers to better understand hand hygiene practices? The answer is simple: Three different types.
- Observed overall performance on hand hygiene practices
- Quantity (mass in grams) of alcohol based hand rub used per 100 or 1000 patient days
- Responses to questionnaires regarding attitudes and perceptions about hand hygiene practices
- Hand Hygiene/Glove Use Observation Tool for recording staff hand hygiene practices (Word)
- Questionnaire for measuring local perceptions and attitudes regarding hand hygiene in healthcare settings (Word)
Some points to consider when using the questionnaire:
- If you are going to observe the quantity of alcohol-based hand rub used, it's best to do the observations before distributing the questionnaire.
- The questionnaire has the potential to raise awareness; thus making your baseline observed level of hand hygiene compliance higher than it was prior to issuing the questionnaire.
- Another interesting point is that in our work and in other published studies, a large disconnect between the self-reported compliance and the observed compliance was noted.
- People don't seem to realize hand hygiene opportunities are being missed: For example, before and after patient contact or after removing gloves.
- Excel spreadsheet for computing grams of alcohol product used per 100 patient days
- Excel spreadsheet for computing grams of alcohol product used per 1000 patient days
Some points to consider regarding measuring product use:
- Doing this for ICU and non-ICU inpatient areas is a challenging but not unrealistic goal. It requires cooperation from a number of areas, such as nursing, supply, logistics, and housekeeping -- everyone involved locally in replacing and tracking the replacement of alcohol hand-rubs.
- It might be best to start in the ICU because the ICU is the most controlled environment in the hospital, patient care is easiest to observe there, and ICU patients are more likely to be seriously harmed by a hospital-acquired infection.
- Though the "powers that be" seem to vary from place to place,
what's really entailed is keeping an accurate record of how many full dispensers replace empty ones within a certain area of the hospital per month. This data needs to be cross-checked with the number of patient days experienced in that same area per the same unit of time.
- This is also an opportunity for non-clinical staff to contribute to improving patient care and might be effectively described to them as such.
- Measuring the quantity of alcohol-based hand rub product used per 100 or 1,000 patient days is surprisingly difficult and requires cooperation from different people and role-players in the hospital. (In our project we tried to do this with four ICUs and were successful with three. One ICU's data included the number of canisters used in a larger area than the ICU - this made the data unusable.)
- Checklist of Interventions developed in VA-3M Six Sigma Project to improve Hand Hygiene Practices (Word)
An obvious question is this: What do we need to do to improve performance on hand hygiene practices, other than just reminding people to decontaminate their hands more often?
- This document describes what we did in our project at four VAMC ICUs. Implementing these interventions in a setting with enthusiastic staff participation and input led to observed overall hand hygiene compliance increasing from 47% to 80% and nearly doubling the quantity of alcohol-based hand rub used.
- It's OK to Ask Buttons (Word)
- Sample Data from four VAMC Intensive Care Units
Sample data collected using the above tools and sample charts of the data.
- CDC Educational Materials to Promote Hand Hygiene in your Healthcare Facility
Participants in VA-3M Six Sigma project and in developing above materials and data:
Noel E. Eldridge, MS 1
Susan S. Woods, BS, MBA 2
Robert S. Bonello, MD 3
Kay Clutter, RN, BSN, MBA 3
LeAnn Ellingson, BSN, RN, CIC 3
Mary Ann Harris 4
Barbara K. Livingston, RN, BSN, CM, CIC 5
James P. Bagian, MD, PE 1
Linda H. Danko, RN, MSN 6
Edward J. Dunn, MD, MPH, MBA, MPA 1
Renee L. Parlier, BSN, MPA 7
Cheryl Pederson, RN, BA 2
Kim J. Reichling, MBA 8
Gary A. Roselle, MD 6
Steven M. Wright, PhD 9
1: Department of Veterans Affairs, Veterans Health Administration, National Center for Patient Safety
2: 3M Company, Minneapolis, MN
3: Department of Veterans Affairs, Minneapolis VA Medical Center
4. Department of Veterans Affairs, Fayetteville Arkansas VA Medical Center
5. Department of Veterans Affairs, VA Central Iowa Healthcare System
6. Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Infectious Diseases Program
7. Department of Veterans Affairs, Veterans Health Administration, Office of the Deputy Under Secretary for Health for Operations and Management
8. 3M Company, Washington DC
9. Department of Veterans Affairs, Veterans Health Administration, Office of Quality and Performance
Additional Acknowledgements: Carol Mieder and Chris Hughes of 3M for help with planning data collection and data analysis; staff at the four VA Medical Center Intensive Care Units for enthusiastic participation and help with data collection; Noel Eldridge (202) 273-8878.