Articles
Do we need 'big brother' or can we design better hand hygiene compliance?
As human beings we are not perfect! However my 6 year old daughter would disagree, saying that she is! Research by Reason1 and others have supported the need to design our healthcare facilities to counter this human failure. But do we need a buzzer that tell people when they left a room and haven't washed their hands? A "big-brother" of hand hygiene compliance.
Research by Ulrich2 and others has shown incorporating safety and quality of care in the designs of our healthcare facilities can improve healthcare outcomes. One of the critical elements to manage our human failing identified in The Crossing the Quality Chasm: A New Health System for the 21st Century3 was access to handwash facilities with the "availability to sinks and alcohol-based hand rubs". While Kaplan's4 research is possibly the foundation for single room design to reduce the risk of HAIs, the community has been slow incorporating these changes into healthcare design. Yet single-room design supports hand hygiene compliance by also increasing sink-to-bed ratios. With St Joseph's Hospital, Reiling5 and colleagues have shown, simply designing and placing sinks at the entrance / exit of rooms is the evidence based reminder to all to wash hands! Yet to get these changes in place takes time. The cost of not doing it for the community is substantial. For Australia it is estimated that it is an additional $22,000 cost per patient for MRSA6. That's $169M a year based on 7000 patients. Of course the human cost is far greater; 20% of those patients are at risk of dying from something that they originally did not go to hospital for. While Swoboda7 et al showed that using electronic monitoring (big brothers) encouraged compliance, the question is whether interior designers, architects and engineers can "design-in" environments that engage us all (children, staff, doctors and visitors) to wash our hands rather "ring us" when we don't.
Did you wash your hands before you left the hospital the last time you visited?
1 Reason J. Making the risks of organizational accidents. Aldershot, England: Ashgate Publishing; 1997
2 Ulrich R, Simring C, Quan X, et al. The role of the physician environment in the hospital of the 21st century: a once-in-a-lifetime opportunity. Report to the Robert Wood johnson Foundation. Princeton, NJ: Robert Wood Johnson Foundation; 2004.
3 The Crossing the Quality Chasm: A New Health System for the 21st Century, Committee of Quality Healthcare, USA 2000.
4 Kaplan, L. M., & McGuckin, M. (1986). Increasing handwashing compliance with more accessible sinks. Infection Control, 7(8), 408-410
5 John Reiling; Ronda G. Hughes; Mike R. Murphy. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor.
6 Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr The Impact of Facility Design on Patient Safety
7 Collignon, P. et al, Staphylococcus aureus Bacteremia, Australia; Centre for Disease Control and Prevention, V11, 4 April 2005