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A New Potential Legal Risk For Poor Handwashing

The "Readily Available" principle

Immersion into the topic of hand hygiene to reduce operational risk has surfaced yet another incentive to improve handwashing process control. Operators know their handwashing rates are low and now they may be open to a charge of negligence should an outbreak be identified.

In Foodservice, including in the kitchens of healthcare facilities, adoption of handwash verification systems is far less than 1%.  In hospital's patient-care locations there is little dispute on the value of data and verified handwashing compliance but yet it is reported that only 3% are currently using this advancement. In nursing homes, where 380,000 residents die annually from a home-acquired infection, it is virtually nonexistent. The usual reasons of cost and manpower were frequently cited as well as the objections to another intrusion of technology and its lack of reliability. Some referenced all the advantages of the direct observation protocol but this group did tend to concede that electronics added the statistical significance advantage by multiplying the observation opportunities. One hospital reported their capability to monitor 100,000 hand washings per day, thanks to automation.

Handwashing For Life interprets this low penetration to be a function of five factors:

  1. C-Suites are not convinced that more handwashing can make a difference in outbreaks.
  2. Having a number does not change behaviors.
  3. Quality Assurance and Infection Prevention are respected for their technical knowledge and passion but are less effective in convincing Operations and Risk Management to install an electronic solution.
  4. Keeping up with the flood of regulations consumes key resources.
  5. Inability to monetize the risk factor of the unwashed hand.

The intense healthcare focus on hand hygiene in the patient room has left the kitchen largely outside the net of current monitoring systems. The kitchen is not seen as a major source of healthcare infections yet In a recent study published in AJIC (American Journal of Infection Control) norovirus, frequently associated with food preparation, was identified as the pathogen most often responsible for shutdown/closure of a hospital unit/department.

The popular World Health’s 5 moments for hand hygiene, ignores the kitchen as a source. Infection prevention and caregivers are often left with the common practice of "Wash In. Wash Out.” This protocol, generally using hand sanitizer, has improved compliance rates and does provide a convenient framework to track a level of compliance. The intent of the 5 Moments is often replaced by the reality of 2 Moments - in and out.

Honesty in reporting is often a theme at major events focused on reducing outbreaks. How could an operation be serious about a path of continuous improvement without a baseline founded on reality? Handwashing For Life's research indicates handwashing rates in healthcare kitchens, patient areas and in restaurants appear to be hovering around 30%. The FDA Food Code is apparently being meet by culinary as their permits are regularly renewed  The Joint Commission audits are known for their rigor but yet approve the operations with 30% compliance, urging their members to report reality rather than the 90% commonly proclaimed. It is definitely time for a reset in all these away-from-home dining situations.

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