It’s not the achievement of the standard its the desire to meet it…

Next week I will be joined for a site visit from Tork looking at the first phase of our hand hygiene project.

Somewhere deep in the busyness of outbreak report writing and case reviews we started talking to the representatives at Tork to take part in a trial using their tool for hand hygiene observation recording. It was so busy at that time, I’ve actually got no recollection where or how I became aware of the system.

I’ve wanted to use an alternative to the paper/ electronic observed audit method for as long as I’ve been completing them. As good as my team are at standing still and blending into the background (nod to Drax: Guardians of the Galaxy Vol 2) what we see occurring in a ward or department is likely to be very different to what was happening before we arrived – commonly labelled as the Hawthorne effect (the nods and whispers spreading the word about the IPC Team arriving spread quicker than Norovirus).

What we do when carrying out an audit is, in my view not really focussed on finding a result but in identifying gaps in practice or knowledge and then finding the opportunity to work with staff to help bridge those gaps with education or to work out ways to modify practice.

It’s not an audit to find a fault.

It’s not an audit to find the reason behind transmission of organisms.

But commonly it’s thought of that way.

It’s also commonly thought that the aim to reach for any ward or department is 100% compliance (against meeting the 5 moments of hand hygiene). There are 2 parts to that sentence that I don’t think work within healthcare.

I don’t like the word compliance, the OED defines it as “the action or fact of complying with a wish or command” not really how modern healthcare works, we don’t expect people to comply with commands but we do want them to know why a task is important and how important their function is in completing it. Compliance works for measuring the standards within a mechanical process or how many lightbulbs are made that work….not how people are able safely deliver care. I think auditing people in that way is demotivating and automatically sets them out to fail.

So can we replace the term compliance with “the ability to meet a standard”.

And the second point, 100%. Every opportunity met, by every person at every one of the 5 moments in a ward over a day is unrealistic. Think of all those interactions with patients. Think of all those moments, when direct interaction is required to save a fall or even a life, prevent a slip, a touch a hand to offer comfort or even delivery of fundamental care. Not every single one of them will be preceded before or followed by hand hygiene. Given the number of activities carried out in every shift by every member of the team we would not get what we need to be done completed in a shift if 100% of every moment was met.

Not that we shouldn’t strive for it.

Don’t get me wrong, hand hygiene is still the cheapest and most effective method of reducing healthcare associated infections. I refer to Didier Pittet in talks more than is healthy. However the more we focus on being able to demonstrate an ethos of recognising hand hygiene as important and why is going to be more effective than reporting and expecting areas to be above 95% to be classed a good.

The opportunity to trial a tool that focuses more on the improvements staff are able to make by matching their hand hygiene behaviours against their movement within a ward environment was too good to let go, despite how ridiculously busy the team (and every other in the Trust) are. I’ll cover more on actually how it works in another blog as we move this forwards.

So, to next week and time to actually meet the team we’ll be working with in person (face to face, a novelty) and walk them around our Trust and learn more about how we’ll work together and assess the impact of the trial. We’ll be starting on two very busy wards and the teams are really excited to be part of this. An ideal opportunity to show more ordinary people doing extraordinary things!