by Albert Villarin

With the Centers for Medicare & Medicaid Services (CMS) expanding its non-reimbursement policy for hospital-acquired conditions (HACs) from Medicare to Medicaid, the need for hospitals to minimize the incidence of HACs has grown more urgent.

So-called nosocomial infections, which originate in a hospital, are responsible for 1.7 million infections each year, resulting in 99,000 deaths and costing the U.S. health system $20 billion annually in extra costs, according to the Centers for Disease Control and Prevention. Although hand hygiene is the easiest and most effective measure to prevent HACs and related deaths, hospitals struggle to attain even a 50 percent plus hand-washing compliance rate by healthcare professionals.

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Several institutions have reported driving compliance from between 30 percent and 50 percent to 80 percent by using people to monitor, educate and provide feedback to clinicians. The improvement is welcome, but facilities would realize superior, more effective, and longer-lasting results using real-time location system (RTLS) technology to police hand-washing than human monitors.

Hospitals typically use RTLS solutions to track the location of patients, physicians and medical equipment in real time, sparing them from wasting time that delays care and scheduled procedures and jeopardizes patient safety. However, some pioneering institutions in the U.S. and abroad are using RTLS to support and increase hand hygiene compliance.

RTLS adopters are experiencing 90 percent plus compliance rates, which upon closer examination is a more impressive achievement than the 80 percent rate reported by hospitals using human monitors. The latter figure is somewhat inflated because it doesn't accurately reflect what occurs at those organizations, which monitor hand hygiene within a short window of time versus around the clock. That skews results artificially higher because not everyone who works at the hospital is observed. Additionally, there's a self-selection bias at play: People will wash their hands when they know they are being watched, but revert back to old habits when they are out of observers' sight.

Like their peers at non-RTLS facilities, clinicians at hospitals using RTLS are quite aware they are being monitored via technology. When a person at a RTLS facility washes his hands, a sensor attached to a soap container picks up the infrared signal emitted by the badge he is wearing. The system automatically records the individual's identity and action whenever a dispenser is used. Depending on how an organization programs its RTLS solution, the system will buzz, beep or generate a message to a doctor's cell phone via the facility's computer system or alert an infection control specialist when the physician enters a patient room without washing his hands.

A major difference between RTLS and non-RTLS users is that the former essentially trains a "mechanical eye" on people 24/7 rather than a brief interval. With RTLS technology, every party knows whether a clinician washed or failed to wash his hands. The data are in black and white and unbiased, leaving no doubt, which is not the case when human monitors are involved. Unlike people, RTLS technology is immune to distractions and can function without rest day after day.

To be sure, a facility can't expect a dramatic turnaround in compliance simply by rolling out RTLS. A hospital's ability to successfully implement the technology, effect fundamental change and influence people to alter behavior learned over the course of a long career hinges on senior leaders delivering a loud and clear message to the rank-and-file. Specifically, executive and physician leaders including the CEO, president, department chairmen, and chief medical officers must champion RTLS to clinicians and staff from the get-go. They must explain that the technology is designed to help personnel deliver safer care, follow best practices and act in patients' best interest rather than get staff in trouble.

A November 2010 report by the Joint Commission Center for Transforming Healthcare, found that hospitals participating in a hand hygiene project significantly overestimated their compliance rate. They thought their compliance ranged between 70 percent and 90 percent, but their actual rate was less than 50 percent. The finding shocked participants, leading the Joint Commission to back off its long-term goal of 90 percent compliance. As of August 2010, participants reported 82 percent compliance rates.

In a study published in the May/June 2009 issue of the American Journal of Medical Quality, researchers reported compliance rates of 26 percent at intensive care units (ICUs) and 36 percent at non-ICUs. After a year of monitoring and feedback, compliance rose to 37 percent and 51 percent for ICUs and non-ICUs, respectively.

The results of those studies show hospitals still have a long way to improve hand hygiene, raise in-house awareness of the extent of the problem, and prevent clinicians from spreading germs and infecting patients. With CMS delaying the effective date of its HAC no-payment policy for Medicaid beneficiaries from July 1, 2011 to July 1, 2012, providers cannot afford to waste time and overlook solutions that can help them avert potential costs that will pressure already thinning margins and budgets. By deploying RTLS as an infection control tool, hospitals can enhance their bottom lines. More importantly, they can keep patients healthier and save lives.

Albert Villarin is an Assistant Professor of Emergency Medicine at Thomas Jefferson University & Hospital. He's also the former chief medical informatics officer of Albert Einstein Healthcare Network, an integrated delivery system in Philadelphia.