By Amanda Sounart, associate editor
Taking a cue from the retail world, hospitals are using "secret shoppers" to improve infection control measures. These covert clinicians observe the hospital staff during the course of their day to see how effective a facility’s infection prevention methods are working—particularly their hand hygiene measures.
"The reason you want to use the secret shoppers is that most hospital staff know the infection preventionist and start running for the sinks," said Pat Rosenbaum, RN, CIC, infection preventionist spokesperson for Association for Professionals in Infection Control and Epidemiology (APIC). "You want to see if the interventions you put into place are actually working."
"Maybe you’ve decided to put signs up about why and how to do hand hygiene," she said. "You might have put up more [anti-bacterial sanitizer] dispensers and want to see if more people are using them. You may decide to use a variety of interventions and want an accurate picture of how effective they are or how to improve them."
When the staff knows they are being observed for hand hygiene, they may act differently than they would during a normal shift. Using a secret shopper allows the infection prevention team to gather a more accurate picture of how effective their current hand hygiene programs are.
The current economic crisis combined with reduced reimbursement measures from the Centers for Medicare and Medicaid (CMS) have forced hospitals to look closely at the expense of hospital-acquired infections (HAIs). According to APIC, HAIs account for approximately 1.7 million infections per year and contribute to nearly 99,000 deaths.
In addition to being deadly, these infections carry a hefty annual price tag of nearly $20 billion.
One of the easiest ways to prevent the spread of infections is through proper hand hygiene, not just among physicians and nurses, but among all hospital employees that come in contact with patients. Finding the best solution for implementing hand hygiene education can often be difficult for infection preventionists, making it vital to find the most effective way to implement change.
"Secret shopper programs are effective in providing some data, which you can then feed back to your units," said Rosenbaum. "You might find out that perhaps they don’t like the product, or the sites for the products are not in user-friendly locations. They may not understand always when they should or should not be using proper hand hygiene. These programs can help you find out the reasons they may not be in compliance and then you can increase the education and prevention measures to increase compliance."
The data from these programs can also show gaps in compliance among certain units. Whether from turnover, lack of education or a lack of resources, these discoveries can help improve hand hygiene consistency across the entire facility.
Rosenbaum also suggests using the data from the secret shopper programs to illicit ideas directly from the staff on how to better implement infection control measures and increase hand hygiene.
"It’s very important to get feedback from staff," noted Rosenbaum. "I’ve found that it provokes a conversation on how they would like to improve things. By getting their help, support, they become more vested in it."
She also noted the importance of relaying to staff why the hygiene measures are in place so that hospital staff members want to comply.
"There needs to be personalization in the education," added Rosenbaum. "Hand hygiene observation isn’t punitive; it’s a way to prevent infections in our patients that can be devastating. They need to remember that these are real people and hand hygiene can prevent death and further injury. I find that very effective when they understand that aspect of it."
"When it’s personal, it reinforces why hand hygiene is so important," she said.
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