Applying Lean Principles to Identify Barriers to Hand Hygiene

Background: Hand Hygiene (HH) is the single best way to prevent the spread of Healthcare Associated Infections (HAIs) and provides an ideal opportunity for application of lean principles to healthcare worker (HCW) behavior. Despite overwhelming evidence and knowledge around the importance of HH, Hand Hygiene compliance of healthcare workers in hospitals across the country hovers between 18% - 45%. Our academic medical center found similarly low rates (average 30%) despite real-time feedback using an aggregate electronic monitoring system. Our team set out to identify barriers to HH performance using Lean tools.

Methods: Voice of the Customer (VOC) interviews were conducted on two adult inpatient units to identify current views about HH behavior, understood expectations for HH performance at our institution, and barriers to utilizing an electronic monitoring system to improve HH compliance. Our team interviewed 51 HCWs including physicians, nurses, environmental services, and support staff, which provided 275 unique barriers to HH performance. The VOC approach engages participants with open-ended questions to allow for a 'brain dump' of unformated information. Responses were recorded and extracted verbatum by a member outside of the team to ensure objectivity. Respondent answers were placed into an Affinity Diagram, allowing for discovery of themetic patterns in reported barriers to performing HH. 

Results: The most commonly reported thematic barrier to performing HH was "It's not me, it's you"- adament statements that co-workers and rounding teams were responsible for the unit's low performance (21%). Distrust in the electronic monitoring system was a theme of 11% of reported barriers including "I don't understand the system" and "I dont' believe the reported compliance is accurate." Finally, perception of HH as unnecessary at all recommended opportunities was noted with responses including "But I'm not touching anything, I washed upon entry so I don't need to wash upon exit, and the room was empty" (8.7%).

Conclusion: Results of this discovery process using Lean tools revealed substantial opportunity for intervention to improve knowledge and attitudes of healthcare workers around performing Hand Hygiene and how compliance is being measured.

Heather Limper, MPH, Clinical Effectiveness, University of Chicago Medicine, Chicago, IL, Rachel Marrs, MSN, RN, CIC, Infection Control Program, The University of Chicago Medicine, Chicago, IL, Samantha Ruokis, BS, Center for Quality, University of Chicago Medicine, Chicago, IL, Sylvia Garcia-Houchins, RN, MBA, CIC, FSHEA, University of Chicago Medicine, Chicago, IL, Emily Landon Mawdsley, MD, Medicine, Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, IL and UCM Hand Hygiene Leadership Committee

Disclosures:

H. Limper, None

R. Marrs, None

S. Ruokis, None

S. Garcia-Houchins, None

E. Landon Mawdsley, None

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