Donny C. Lambeth, President
North Carolina Baptist Hospital (part of Wake Forest University Baptist Medical Center)

As an academic medical center, it’s part of our mission at Wake Forest University Baptist Medical Center to improve health care quality and safety. Participating in this national collaborative with the Center for Transforming Healthcare and The Joint Commission is a great opportunity to share our innovations in improving hand hygiene compliance and to learn from others.

We’ve known for a long time that hand hygiene compliance is not a simple problem to fix. It’s not just a matter of expecting people to clean their hands – you have to create an environment that makes it easy to comply. That requires systematic process analysis and improvements to identify and overcome barriers -- both environmental and behavioral. It also requires real commitment from institutional leadership that this is a problem that must be fixed, with resources to support it. Wake Forest Baptist is committed to applying a systematic process improvement approach that will ensure quality patient care.

We are very excited about our pilot project now under way in selected intensive care and medical/surgical patient care units. It combines the efficiency of an optimized patient care-workflow environment with the power of radiofrequency identification technology to reinforce hand hygiene compliance.  

Our process started with a comprehensive environmental assessment of the pilot units, along with an analysis of workflow processes in each setting. Our multidisciplinary process improvement team charted every step that health care workers take to care for patients in the targeted areas, identifying multiple challenges to hand hygiene compliance. Next, the team determined the optimal locations for hand hygiene stations, medications, supplies, and materials for disposal. Every step was evaluated to minimize the need for health care workers to leave the patient‘s care environment to accomplish required tasks. The pilot areas now include, for example, computers and barcode medication scanners at the bedside rather than on shared carts, which eliminates the need to cross the patient care threshold and perform hand hygiene again.

We’ve made it easier to comply with hand hygiene in this setting because the environment is designed to support that objective. But we know that even the best of intentions sometimes fall short, and that’s where the technology piece of our project comes in.

Now we are piloting a promising and innovative Real Time Location System (RTLS) technology that will monitor and track hand hygiene compliance in our test areas.  Employees in these units wear badges with embedded electronic chips that track their utilization of hand hygiene stations. Hand sanitizer stations contain corresponding chips that track the employee’s relationship to the patient care threshold.

We will soon add a reminder component to the badge system, using technology that is being developed to meet our specifications. This feature will alert employees when they approach the patient care threshold before utilizing the hand hygiene station. The anticipated result is that neglecting to sanitize your hands will be a lot harder to do.

While we are still in the data gathering phase of these projects, we are confident that our interventions are soundly rooted in sustainable processes. The data capture will allow us to evaluate the compliance of different types of employees in different patient care environments and provide managers with individual compliance reports for enhanced accountability. With these tools, we believe we can significantly improve hand hygiene compliance.

Wake Forest Baptist is honored to participate in this powerful collaborative with The Joint Commission to improve quality and patient safety.