Clostridioides difficile (C diff) remains one of the most stubborn and preventable healthcare-associated infections, causing an estimated half million infections, tens of thousands of deaths, and billions of dollars of burden in the United States each year.¹ Despite decades of infection prevention efforts, C diff continues to challenge hospitals, in part because its hardy spores resist alcohol-based hand sanitizers.² For hospital staff, the only reliable defense is washing with soap and water every time.²
Yet compliance is far from perfect. Despite established guidelines, hand hygiene compliance remains a persistent challenge in healthcare environments, with too many opportunities for handwashing still being missed.³ Numerous studies have shown gaps between policy and practice, particularly when dealing with infections like C diff that require different hygiene responses.³ So how can we ensure staff follow through every single time?
Case Example: West Region Hospital Study (2017–2020)
A compelling example of progress in this area comes from an approximately 400-bed West Region United States General Acute Care Hospital that deployed an electronic hand hygiene monitoring system (EHHMS) in 2017. The hospital had historically been performing high in terms of quality ratings, hospital grades, and had low instances of four of the five Centers for Medicare and Medicaid Services’ (CMS) Healthcare Acquired Conditions. The hospital chose to implement the EHHMS to combat an issue the facility had with C diff infection rates, the one CMS hospital acquired condition where they did not have low instance.
The EHHMS, designed to include behavior modification reminders and room-specific contact precaution settings, tracked a total of 20,067 hand hygiene events involving C diff patient rooms during a three-year (2017–2020) time frame. Data revealed that 58.7% of handwashing events were performed properly without prompting. Another 28.9% of staff initially attempted to use hand sanitizer but were then prompted to use a sink for proper handwashing. The remaining 12.4% of staff made no hygiene attempt initially but performed handwashing after receiving a timed reminder.
As the EHHMS allowed for a form of CDI patient isolation and reminders to wash hands, the hospital did report a significant reduction in observed cases of healthcare-acquired C diff in their facility. The hospital obtained over a 50% reduction in C diff cases at its facility in the first year alone, and an 84% reduction over the four years between 2017 and 2020. As a result of their hard work, the hospital received prestigious awards for both patient safety and innovation.
Discussion
These findings highlight both the challenge and the opportunity in promoting effective hand hygiene when combating C diff in healthcare environments. While over half of healthcare staff performed the correct protocol independently, a significant portion still required either correction or prompting. This underlines the importance of room-specific contact precautions and real-time reminders tailored to specific hygiene actions that mitigate infection risks.
Limitations
While the study presents promising results, it is important to consider its limitations. The study’s scope was limited to a single facility, potentially limiting the generalizability of its findings. Additionally, while reminders improved immediate compliance, it is unclear whether these changes persisted without the presence of monitoring. Technical limitations of electronic tracking systems may also have an impact on the accuracy of the data collected.
Conclusion
The evidence is clear: when we remind, we prevent. When we prevent, we protect patients. As C diff continues to pose a significant threat in healthcare environments, it is essential to reinforce the importance of proper hand hygiene. Electronic monitoring and behavioral prompts have proven to be effective tools in increasing compliance, particularly in settings where traditional methods fall short, making the difference between containment and transmission. Healthcare leaders must invest in broader adoption of technologies and practices that reinforce proper hand hygiene at the point of care.