Hospital Hand-Washing – how long should it take?

There is a large literature on the importance of frequent hand washing in hospitals, to prevent spreading infectious diseases among patients. It’s a major problem, since hospital-caused infections are growing, and have nasty effects.image5b135d

Brad Stats recently sent me two papers he co-authored on the topic. Both are based on an analysis of  behavior by 4100 caregivers. They led me to ask two sets of questions. First, if everyone did comply with the recommendations on hand-washing frequency and duration, how much time would it take out of their work day? Second, while there have been lots of projects using  electronics for monitoring compliance, has there been any work on straightforward manufacturing-style interventions to make compliance easier?

Here are my questions in more detail, taken from an email to Brad.

Has anyone done an Ops Management analysis of hand-washing when providers enter patients’ rooms?

Observing nurses when family members were in the hospital, the 30 second washes really add up. I don’t know the data on how many room visits per hour nurses make, but if they make 10 and washes are supposed to take 30 seconds each (once on entry, once on exit) this would be 10 minutes per hour.

I took a quick look at Brad’s paper and the supplemental material, but I did not see numbers that would allow calculating “hand washing opportunities per shift” or per hour. Preferably by type of provider?
This would give a gross estimate of effect. A more complete estimate might require a queueing model of nurses’ time.

Also, in the TQM paradigm we should use jidoka or something similar. For example, an automated hand-cleaning station. Once you put your hands under the faucet, no further control action is needed by the provider. The right amount of soap and water are dispensed automatically. Is this done anywhere?

Finally, why don’t providers use disposable gloves more? It could be that they are slow to don and doff. But 30 seconds of provider time is worth roughly $.30, while gloves cost a few cents. Again, a jig or automated process for donning gloves could increase compliance.

A recent review of 41 studies seeming found only 1 that was remotely close to what I’m suggesting:
>Chan BP, Homa K, Kirkland KB. Effect of varying the number and location of alcohol-based hand rub dispensers on usage in a general inpatient medical unit. Infect Control Hosp Epidemiol2013;34:987-9.CrossRef

The review is: Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis
BMJ 2015; 351 doi: (Published 28 July 2015)
Cite this as: BMJ 2015;351:h3728

I did find one estimate of frequency: 27 “hand hygiene opportunities” per 12 hour shift. That is  only 2 per hour, which I find hard to believe. I am sure at least the frequency question is answered somewhere in Brad’s data. The two papers are:

Dai, H., Milkman, K. L., Hofmann, D. A., & Staats, B. R. (2015). The impact of time at work and time off from work on rule compliance: The case of hand hygiene in health care. Journal of Applied Psychology100(3), 846.

Staats, B. R., Dai, H., Hofmann, D., & Milkman, K. L. (2016). Motivating process compliance through individual electronic monitoring: An empirical examination of hand hygiene in healthcare. Management Science.

There must be a medical reason that gloves are not used instead of or as a supplement to washing. Anyone?

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