Six Years of Monitoring Hand Hygiene Events and Sanitizer Usage in United States: A Multicenter Study Using Product Volume Measurement

Background:  Product volume measurement (PVM) is an indirect approach to assessing adherence to hand hygiene (HH) recommended guidelines on performance.  The CDC, JC, and WHO reference PVM in their guidelines as part of a multimodal hand hygiene program. Compared to other methods of measurement, PVM is less resource intensive, more cost effective, and reduces sampling bias.  The method can be implemented in any healthcare facility.  Data can be captured from all healthcare workers' (HCW), shifts, and tallied manually or with electronic devices that monitor product use.  The reliability and validity of PVM requires a standardized procedure and analysis that can be adapted on a broad geographic scale as demonstrated by our database.  Guidelines strongly recommend sanitizer usage and our database has been tracking usage trends for six years. 

Objective: To report on HH events/trends and sanitizer usage in United States (US) over a six year period using PVM a standardized reporting procedure.

Methods:   Since 2004, McGuckin Methods International (MMI), a Patient Safety Organization (AHRQ) has maintained one of the only databases in the US for HH compliance monitoring for hospitals that implement HH PVM.  All sites in our ongoing program follow a standard procedure for collecting and submitting data. For each patient care unit at a hospital, the volume of soap and sanitizer used each month and patient census, are submitted to our data analysis center. We determined how many HH events were performed as well as compliance and benchmarking using 24 variables.  Sanitizer usage is determined as a portion of all HH events performed for each month

Results: During the period 2004 to 2009, 4271 ICU data points and 13,467 Non-ICU data points were submitted to MMI for analysis. Figure 1 shows that HH per bed day (events) was 43 for ICU and 28 for Non-ICU. The percentage of HH events that used sanitizer rather than soap was 47% for ICU and 43% for Non-ICU. Stratified by bed size category, HH events were the lowest in facilities with 101-300 beds (36 events for ICU, 25 for Non-ICU) and the highest from sites with over 501 beds.(61 events for ICU, 31 for Non-ICU). Overall there has been a downward tend in sanitizer usage. In 2004 sanitizer usage for ICU was 47% and in 2009 decreased to 42%, for non-ICU it was 46% in 2004 and 32% in 2009. 

Conclusions:  Results from our robust database continue to document that HH events in US occur less often than required. In fact, if we apply minimum compliance data of 6 HH per hour for ICU and 3 HH per hour for Non-ICU, our findings would show that HH events occur on average 36% of the time for ICU patients and 44% of the time for Non-ICU patients. Although PVM cannot provide data on the opportunities and techniques for HH, it can provide a cost effective way to educate staff at the unit level and determine where observation fits into your multimodal hand hygiene program.