Hand-Washing Validation Kits Debut at University Community Hospital

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From the minute Debbie Martoccio, RN, BSN, MBA, CNAA-BC, vicepresident of patient care and chief nursing officer at UniversityCommunity Hospital, Tampa, saw the prototype for Medline's HandWashing Competency Validation Kit last year, she couldn't keep herhands off of it. And when she introduced one of the beta testmodels at the hospital in April, the staff felt the same way.

"I saw the prototype for the kit and I said, 'Wow, I could usethat!'," says Martoccio. The portable kit, which was rolled out atUCH and sister facility UCH-Carrollwood in mid-April, is believedto be the first of its kind in Tampa Bay hospitals and, accordingto Marc Lessem, divisional vice president at the device'sIllinois-based manufacturer, Medline Industries Inc., it provides areliable way to validate competency for staff being trained onproper techniques for hand antisepsis.

The kit works by adding 10 mls of the company's liquid Visirub, afluorescent marker used for demonstration and training purposes, toa 500 ml bottle of Medline's alcohol-based, waterless handsanitizer Sterillium Comfort Gel, and applying the proper volume ofthe mixture to the hands. Then the hands are placed into a smallbox affixed with a black light clipped to the top, which givesvisual confirmation on how well the mixture was applied and whatspots were missed.

"You can see instantly. Did you apply it to both hands and did youget under the fingernails as well as other commonly missed areas,like the thumb and interdigital spaces?," says Lessem.

If used properly, under the black light, the validation kit's userwill see a chalky substance on his or her hands that shows wherethe product was applied properly. If an area does not have thatchalky look, it indicates a gap in coverage.

Lessem says Medline's kit is the first of its kind that can beadded to an alcohol-based sanitizer and provide feedback on howwell the product has been applied. "Evidence supports the use ofalcohol-based hand sanitizing gels, but healthcare workers mustalso be trained on proper application technique," he says. "Weought to be training healthcare professionals to put gel in thepalm of one hand and dip the fingertips of the opposite hand intothe pools before spreading the gel, then repeat with the other handand fingertips. Utilizing this application technique addresses theareas of the hands [fingertips] where high counts of microorganismscan be found."

The immediate feedback provided by the kits makes them useful tothe staff at UCH, says Jackie Whitaker, RN, NPSG, infection controldirector and national patient safety goal administrator at thehospital. "We used to use this UV glow light that was a stand alonethat you had to walk up to and it was bulky, but with the kit youcan pick it up and take it with you." UCH ordered 20 kits (withfive going to Carrollwood).

When the unit patient safety officer in the ICU took one out anddemonstrated it for the staff, "everyone walked by asked what itwas, and the physicians, nurses, and transport staff all got hookedinto seeing how well they were washing their hands," Martocciosays.

Hand washing affects bottom line

With government reimbursement for hospital-acquired infectionsending later this year, Martoccio says the pressure is on forhand-washing compliance to fall into line. Among the U.S. Centersfor Disease Control's recommendations are periodic monitoring ofhand hygiene adherence, providing feedback to personnel regardingtheir performance, and monitoring the volume of alcohol-based handrub used per 1,000 patient days.

Whitaker says unit patient safety monitors have electronicmonitoring tools to check hand-washing compliance and scan thatinformation into a database monthly, with the information reportedup to the hospital's board.

The goal of the UCH program is to increase hand-washing compliancegiven that 70% of infections are spread through the hands, butMartoccio says it is also to fall in line with goals set out by theJoint Commission to reduce hospital infections. Among those goalsare for hospitals such as UCH to fall in line with CDC and WorldHealth Organization hand-hygiene guidelines. "The Joint Commissionsays you need to have measures in place that allow you to monitoryour compliance of your medical and clinical staff with handhygiene," Whitaker says.

Between the 53 unit patient safety officers at UCH and the 10 atCarrollwood, Martoccio says she could easily have ordered 50 kitsand still not had enough to satisfy demand. Once the units areavailable for sign-out, the officers will be able to obtain one fora week and then return them so that they can go to another unit.

Because UCH is part of a pilot program for the use of thecompliance kits, the demonstration kits are being provided to themat no cost. Lessem estimated that the implementation of the Medlinekits (which include the box, the light, two vials of Visirub and a500 ml bottle of Sterillium) would likely cost around $135 each.Though the kits have only been in use since December, he estimatedthat the life of the system should be "years," with frequentrefills needed for the liquid rubs.

Whitaker says one of the unit patient safety officers told her astory that indicated the kits are very likely improve hand washingbehaviors. "One of the officers from one of our operating rooms putsome Visirub on people's lockers and then had them change clothesand 30 minutes later she gathered them in an administrative areaand put a UV light on their hands," she said. "She was trying todemonstrate how cross-contamination happens on all surfaces and onyour body and clothing. People had no idea that cross-contaminationcould occur like this, so it was very effective."

Gil Kaufman is a freelance writer.

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