Hospital-Acquired Infections -- The Real Story

While no one in health care doubts that increased hand hygiene will significantly reduce infections, the question has always been how to ensure that proper hand hygiene is consistently practiced.
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Did you go into the hospital recently for a routine operation or problem and come out with a nasty hospital-acquired infection unrelated to your illness? If you have, you are not alone. If you haven't, you are one of the lucky ones.

I first became truly aware of hospital-acquired infections (HAIs) when, within a short period of time, both my sister and my mother became ill during hospital stays. They were in the hospital at different times for different reasons, but both contracted debilitating infections during their stays.

My company had developed a highly-effective remote video auditing (RVA) service for the meat processing industry to monitor production processes and reduce E. coli and other types of contamination. The program has worked extremely well. After the incidents with my mother and sister, and with the urging of my physician father, I realized I needed to turn my attention to health care.

What I found was unnerving. About one in 20 hospital patients each year will be victims of an HAI. Around 100,000 of these individuals will die as a result, which is the equivalent of a large passenger plane crashing every single day of the year. Even more disturbing, Leapfrog Group, a health care watchdog organization, recently published a report card on hospital safety procedures nationwide. Some of the statistics around hospital-acquired infections (HAIs) are particularly eye-opening:

• 65 percent of participating hospitals do not have recommended policies in place to prevent common HAIs.

• 75 percent do not meet the standards for 13 evidence-based safety practices, ranging from hand washing to nursing staff competency

The key in the second bullet point is hand washing. In one recent academic study, the average hand washing rate among health care workers, including doctors and nurses, was under 10 percent. Hand hygiene has long been known to be a critical preventive measure in the fight against HAIs. However, in the hustle and bustle of daily hospital routine, it often gets overlooked. It's not because health care staff are lazy or don't care. It's because the importance of hand hygiene has not been emphasized in a way that influences actual behavior, and compliance has not been consistently monitored to improve and sustain high levels of hand washing.

Given the trauma endured by my mother and sister, I became very motivated to try to help solve this problem. With input from health care professionals, we have developed a Remote Video Auditing service using video cameras and software, which is monitored by unbiased remote observers to help hospitals significantly increase hand hygiene compliance. This is done through real time feedback to staff via electronic scoreboards that are continually updated to encourage compliance and let them know how they are doing. It is done in a positive, team-building way that has been embraced by health care workers as a way to help them do better for their patients. The impressive results have been recently published as an academic study in a medical journal, which details how North Shore University Hospital of Manhasset, N.Y. used RVA services to improve baseline hand hygiene rates from under 10 percent to more than 80 percent in less than four weeks. In a separate recently-published study from the U.K., where HAI issues are also prevalent, there has been a confirmed link between hand hygiene and reduced HAI rates. The study shows that instances of MRSA and C difficile, two of the most common and deadly HAIs, were reduced by close to 50 percent through a national campaign to increase hand hygiene.

While no one in health care doubts that increased hand hygiene will significantly reduce infections, the question has always been how to ensure that proper hand hygiene is consistently practiced. Conventional methods of observing worker performance is challenging because their behavior is usually more compliant when they know they are being assessed. Now that there is a proven and validated method using unbiased RVA services, we are hopeful that more hospitals will elect to use these services to address their hand hygiene issues. However, if the poor adherence to patient safety measures as shown by the Leapfrog survey continues to persist in U.S. hospitals, then it will fall on the provisions of the recently affirmed Affordable Care Act to drive hospitals to take steps to prevent HAIs. The language in the Health Care Act stipulates that in the coming years, hospitals will begin to not be reimbursed for costly HAIs. Either electively or by financial penalty, the health care industry will need to begin investing in ways to prevent HAIs. By doing so, there will be a sharp reduction in completely avoidable patient suffering and loss of life.

Adam Aronson is founder and CEO of Arrowsight, Inc., a developer and service provider of remote video auditing (RVA) technologies for a variety of industries, including health care. He can be reached at

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