Do you know how much hand sanitizer and soap your surgical team goes through every week? Coupled with direct observation, the simple act of tracking your hand-hygiene compliance is a good way to improve compliance. Our state hospital association asks each facility to measure the amount of liquid hand sanitizer and soap it uses. We then use a simple formula to measure compliance. You divide the number of surgical patients by the number of empty sanitizer and soap containers. Every surgical patient should generate 72 hand-sanitizing episodes of about 1ml each, according to research pioneered by Maryanne McGuckin, DrScEd, MT, at the University of Pennsylvania in Philadelphia.

We place empty sanitizer containers in buckets in soiled utility rooms, where we count them every Friday. We send our data on sanitizer consumption and bed-day statistics to the hospital association monthly. The association sends us back a report with charts that we post and present at meetings throughout the hospital. Each unit receives a report on its compliance. Should an outbreak of infection occur, we could easily assess the adequacy of our hand hygiene. Here are 5 other tips to help you reach perfect compliance.

1 Measure, then act
Gathering compliance data is only the first step in a successful hand-hygiene program. You have to act on what you've learned. No matter what your compliance level is, encourage staff to sanitize their hands between each step of patient care and correct them when they slip up. Direct observation is the best way to do this. At our facility, managers spot-check compliance, and everyone — including patients and their family members — is encouraged to speak up when they see someone skip sanitizing entering or leaving a room. Our motto is "Gel In, Gel Out."

Quality assurance nurses also check for hand-hygiene compliance as part of their quality surveys using tracer methodology. In this process, the quality assurance nurse chooses a chart at random and traces all the steps that were taken to ensure quality care from the time the patient arrived in the facility. This gives us a real-time view of what's going on throughout the facility.

2 Get buy-in from the top down
To keep a hand-hygiene program successful year after year, it's important that staff and physicians buy into the program. This is especially true for top administrators, since they set the tone in the facility. We're lucky that our chief executive is a nurse and she "gets it." She receives our monthly compliance reports. Any unit below 100% compliance gets a phone call or visit from her asking about the plan to improve compliance and whether there are any barriers to compliance. This attention from the top is key to our success. Everyone is constantly reminded of our commitment to maintaining high hand-hygiene compliance. It's a part of every clinical employee's annual goals. Compensation is tied to meeting system objectives, so every employee in invested in the program's success.

3 Work on barriers
When you do identify staff members or physicians who are repeatedly observed skipping sanitizing their hands when they should, sit down and talk with them. Work with them to identify their barriers to compliance. It's usually not a deliberate omission. There's a good chance that there's a reason. You should be able to tell the difference between an excuse and a valid barrier. For example, a common barrier is that the gel makes their hands dry or causes an allergic reaction. You can remedy this by purchasing non-allergenic gel for that person. Purchasing high-quality gel with emollients that moisturize the skin while sanitizing helps encourage compliance among the staff in general because applying this type of sanitizer feels good on the hands. How-ever, if a staff member continues to be non-compliant after discussions and making accommodations, you may have to resort to disciplinary action.

4 Put gel where it's needed
Healthcare providers should sanitize their hands when they enter and exit a room as well as between each step in caring for the patient. Besides doorways, look for other spots to place sanitizer dispensers that will encourage their use. Attach dispensers to anesthesia carts, computer workstations and at the bedside in the PACU bays. Don't forget areas where non-clinical employees work. Proper hand hygiene protects more than patients. It can help reduce the spread of the flu and colds in your facility and help reduce absenteeism.

5 Educate patients
In a surgical facility, plenty of germs come right through the front door with patients. Educating patients about sanitizing their hands can help you reduce your infection rate. As soon as patients and family members arrive, ask them to sanitize their hands. Tell them to make sure that they see healthcare workers sanitizing their hands. We have permanent signs on the doors in clinical areas that remind everyone who enters to sanitize their hands. Our goal is for patients to see us sanitizing our hands and understand the importance of it.