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Handwashing: Frequency vs. Quality

Collaborative handwashing assessment

Sixty-two healthcare culinary professionals volunteered to share their opinion of handwashing at their establishment, a kitchen in either a hospital or nursing home in the Midwest.

The objective of the qualitative research was to highlight the two primary dimensions of handwashing, the quality of the outcome and the handwash frequency. Each requires a very different solution. This exercise serves to raise awareness when assessing the risk of outbreaks and provides guidance for improving both the quality and frequency, using the standards of continuous improvement.

Each participant was asked to align a dot on a chart representing the quality of the wash - the “percentage of safe” reached on average by all the kitchen staff. They were then asked to affix their dot to the chart where the quality line intersects their estimate of handwash frequency – the “percentage of safe” reached on average again by the total kitchen staff.

Results displayed on the chart revealed first that handwashing was well below a safe level in both quality and frequency. Secondly, the quality fared better than the frequency. There is not even one dot in the quadrant representing high frequency and low quality. The patients and residents being served at the facilities identified in the lower left quadrant are clearly at risk. Their staffs are grossly failing on both measures. Even those served in the upper right are huddled far from safe. The far upper right, where the 10s meet, are the levels the participants considered safe. The nearly blank lower right quadrant suggests that those doing well on frequency also are doing quite well on quality. The upper left shows many of the people low on frequency are high on quality. "They don’t wash often but when they do, they are thorough” reported one of the participants in a moment of reflection.

The call for standards

The most impassioned comments came along with the ratings in low quality-low frequency area. Of those standing around the open voting, there was a feeling that these 10 people were the most honest. There was one pair of voters who approached the chart and after the senior of the two documented her view, the junior person returned her dot without voting. Resolving these issues starts with setting agreed standards. The Handwashing For Life’s ProGrade protocol is one simple but effective alternative for setting the quality expectation: 

A frequency standard is next but without a tracking system to verify, this is generally an ineffective exercise. Verification is a game changer when wanting to improve on the frequency dimension: 

Electronic handwash monitoring can be a major help in kitchens where observational protocols are proving ineffective. Handwashing For Life® proposes operators use this simple qualitative instrument in taking the pulse of their handwashing. The exercise increases the discussion, raises awareness of issues, guides training and shines a light on possible risk-based solutions. It is another helpful tool to initiate collaborative solutions.

[Note: When this same exercise is conducted in non-healthcare foodservice, mainly restaurants, the clustering now seen in the upper right moves to the upper corner of the lower left. Might this reflect higher staff turnover in non-healthcare foodservice and/or might there be a higher level of concern and commitment due to the immune compromised residents and patients? Or is this too much of a stretch of participants’ approximations to draw such conclusions?] 
File Attachment: 
PDF icon ServeReady Frequency vs. Quality3.96 MB

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