The hospitals that 'fail' at handwashing

Urban hospitals outperforming rural counterparts on proper hand hygiene

Almost a quarter of hospitals have not yet implemented necessary hand hygiene strategies to keep hospital-acquired infections (HACs) at bay, a new report by The Leapfrog Group and Castlight Health finds.

The report used data from the 2014 Leapfrog Hospital Survey of 1,501 U.S. hospitals and is one of six Leapfrog reports measuring specific quality and safety benchmarks.

To assess whether hospitals had proper hand hygiene policies, Leapfrog and Castlight determined whether they followed 10 recommended hand hygiene safety practices, including:

  • Implementing hospital-wide hand-hygiene education;
  • Submitting a report about hand-hygiene recommendations to the hospital's board of directors;
  • Denoting all expenses related to hand-hygiene education;
  • Creating policies and procedures to prevent hospital-acquired conditions because of improper hand hygiene;
  • Developing and monitoring performance-improvement initiatives related to the prevention of HACs; and
  • Holding leadership accountable for hand hygiene.

According to CDC, hand hygiene is one of the most effective ways to stop the spread of HACs. The agency estimates about one in 25 patients acquires an infection while in a hospital, and about 10% of those patients die as a result.

How can you make people wash their hands? Gross them out.

'No excuse' for hand hygiene shortcomings

Leapfrog President and CEO Leah Binder says, "there's no excuse for a hospital to fail on hand hygiene," yet many hospitals continue to struggle to meet hand washing guidelines. For instance, the report found that urban hospitals are outperforming rural hospitals when it comes to hand hygiene protocols, with 20% more urban hospitals meeting Leapfrog standards than their rural counterparts.

The report also included promising news, such as an 8% increase in hospitals who met hand hygiene standards from 2013 to 2014. And 99% of hospitals had adopted organization-wide education and training programs for preventing HACs related to poor hand hygiene.  

On performance improvement
Hand hygiene programs: What really works?

"While we trust our doctors and nurses to make us well, many [HACs] are caused by the contaminated hands of health care workers," says Jennifer Schneider, CMO at Castlight Health. She explains, "Hospitals must not only put the right policies in place—they must also enforce them" and calls enforcing hand washing guidelines "one of the easiest steps a hospital can take toward patient safety."

The states with the best and worst hand hygiene practices

The report found significant geographic discrepancies in handwashing compliance. In five states, nearly 90% of reporting hospitals met all hand hygiene guidelines; but in six other states, just 60% or less of reporting hospitals met such guidelines.

It took five years—but a hospital got (almost) everyone to wash their hands

The top five states were:

    1. Oregon (with 100% of hospitals complying with handwashing regulations)
    2. New Jersey (94%)
    3. Florida (93%)
    3.  Nevada (93%)
    5.  Tennessee (90%)

The bottom five states were:

    50. Wyoming (44%)
    50. Wisconsin (45%)
    48. Arizona (50%)
    48. New Mexico (50%) 46. Missouri (59%) (Greene, Crain's Detroit Business, 6/11; Leapfrog release, 6/11; Leapfrog report, May 2015).

The takeaway: A new Leapfrog report finds that nearly 25% of hospitals have failed to implement effective handwashing programs, with rural hospitals doing a worse job on hand hygiene than their urban counterparts.

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