PSMF APSS Challenge 2: Healthcare-associated Infections (HAIs)

N.B. — This post is based on one of the continuously expanding roster of Actionable Patient Safety Solutions (APSS) a.k.a. “Challenges” as defined and described by the Patient Safety Movement Foundation (PSMF) and published at its web site (http://patientsafetymovement.org/challenges-solutions/actionable-patient-safety-solutions-apss/). Because the Foundation has set a goal of Zero Preventable Patient Deaths by 2020 (http://patientsafetymovement.org/), these APSS are understood to represent the most significant patient safety exposures created by medical mistakes, and medical mistakes are the third most frequent cause of patient deaths following heart disease and cancer (http://www.bmj.com/content/353/bmj.i2139).

“In order to implement a program to improve hand hygiene and reduce healthcare-associated infections (HAIs), the following implementation plan will require actionable steps (The following checklist was adapted from the WHO Hand Hygiene Self-Assessment Framework):

  • Commitment from Hospital governance and senior administrative leadership to address this major performance gap in their own organization by taking action
  • Mandate a hand hygiene protocol that is supported by hospital leadership
  • Continually monitor hand hygiene and post results – the goal is 100% compliance
  • Empower patients to ask their provider “Have you washed your hands?”
  • System change to ensure that alcohol-based handrub is easily available, there is a continuous supply of clean running water and soap at each sink, and a budget to replenish alcohol-based handrubs
  • Dedicated hand hygiene team dedicated to the promotion and implementation of optimal hand hygiene practice in the facility
  • Mandatory training for all professional categories at commencement of employment, then ongoing regular training (at least annually)
    • Educational resources easily available to all health-care workers (ex: WHO Guidelines on Hand Hygiene in Healthcare: A Summary)
    • System in place for training and validation of hand hygiene compliance observers
    • Dedicated budget that allows for hand hygiene training
  • Evaluation and Feedback
    • Ward infrastructure survey regarding availability of hand hygiene products and facilities performed annually
    • Indirect monitoring of hand hygiene compliance through consumption of alcohol-based handrub and soap
    • Direct monitoring of hand hygiene compliance through hand hygiene monitoring technologies
    • Immediate feedback to healthcare workers at the end of each hand hygiene compliance observation session
    • Systematic feedback of data related to hand hygiene indicators and trends given monthly, as well as every 6 months
  • Reminders in the workplace such as posters, brochures, leaflets, badges, stickers, etc.”

The foregoing quote constitutes the “Executive Summary Checklist” from the above-captioned PSMF APSS Challenge #2 (http://patientsafetymovement.org/wp-content/uploads/2016/02/2-HAI-April-2016.pdf). Although the included bullet points are laudable and appropriate, they relate for the most part to administrative and technical “human factors” and personal discipline to comply, all of which inherently are problematic for reliably repeatable execution. However, the items “Direct monitoring of hand hygiene compliance through hand hygiene monitoring technologies …, Immediate feedback to healthcare workers at the end of each hand hygiene compliance observation session … [and] Systematic feedback of data related to hand hygiene indicators and trends given monthly, as well as every 6 months …” lend themselves to information technology (IT) enablement a.k.a. automation. These are the opportunities for a CHARTSaaS reference architecture-compatible solution to reliably mitigate mistakes and to save lives. Please validate this proposition to your own satisfaction by reviewing the details of the Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS) and its reference architecture in these presentations and imagining an IT solution:

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