Hospital Hygiene in Hungary: The implementation of daily work is lagging behind!

„Bringing hand hygiene to the national level – the case of Hungary“: The Co-Founder and CEO of HandInScan, is cautiously optimistic that the situation will improve.

What is the current situation like in Hungarian hospitals when it comes to hygiene?

Over the past two years, a lot of attention was paid to hospital-acquired infections, which is partially due to the numerous public and professional events organized in the memory of Ignaz Semmelweis. Unfortunately, despite some truly valuable initiatives and some programs on minister-level allowing hospitals to invest into infection prevention, it remains to be a highly political topic, where core facts and data is kept from the public. The National Center for Epidemiology has been promoting the WHO good practices, which have become a standard in education across the country. Yet, the implementation in the daily work is lagging behind. Official reports (on national level, sent to ECDC etc.) picture a great progress in the past years with EU-record low infection ratios. If we go into details, it cannot be traced how the Hungarian system could perform better than the German or the Dutch one, the lack of resources is staggering.

What are the measures that should be taken to bring hand hygiene (in most of the hospitals) to a „national level“ and what exactly is meant by „national level” in your point of view?

We believe that everything starts with proper education. After many years of pilots and trials, HandInScan was the first in Hungary to offer a ministry accredited hand hygiene training program to healthcare workers, bringing it to thousands of people across the country. Further, we have been an integral part of the Medical Doctor training program at Semmelweis University for a long time, and since last year, all Hungarian surgical residents are obliged to use our technology in order to acquire proper knowledge about hand hygiene. We amend the practical skill training with theoretical education. We are currently working on a new project with the Hungarian authorities to make technology-supported patient safety education a standard at all relevant national higher education institutions.

What is your experience in those hospitals, where your system has been implemented? And can you cite an important study in this context?

Currently, joint studies are being conducted in four key European hospitals (AKH Vienna, HUG Geneva, Charité Berlin and University Hospital Ghent) and 15 Hungarian sites are partners in close reporting for continuous improvement of the technology and its implementation practices. We believe in evidence-based medicine, like Ignaz Semmelweis did. All of our claims have been supported by national and international studies, and we have already consulted and supported more than ten graduate students. Even more are working on building new evidences. One important study, for example, is “Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure” published in the Journal of Hospital Infection in 2017.

In which way does the Semmelweis Hand Hygiene Solution (developed by HandInScan) differ from other systems for monitoring hand hygiene compliance?

There are many aspects which make the Semmelweis Hand Hygiene Solution unique.

Our technology is considered to be a Total-Quality-Management solution that employs digital measurement stations – quality check points – optimized training tools and a unique reporting system for management. The core of this technology is digital imaging combined with proprietary software technology to create objective assessment on the quality of hand hygiene. It has been proven that the application of the HandInScan management system fosters cotinuous quality improvement. HandInScan can also teach the validated WHO’s 6-step hand washing protocol (part of the US CDC recommendation and EN1500), with higher cost effectiveness and less human effort. Effective hand hygiene was shown to decrease HAI by at least 30 Percent. In our experience, institutions, which started using the Semmelweis Scanner, observed a rapid improvement in the quality of hand hygiene.

We believe that one of the main advantages of the Semmelweis Scanner is its objectivity. The device relies on 100 % objective feedback based on digital technology, thus there are no human efforts and errors involved. The poster presentation from Viola Sari at the Third CEE Conference dealt with this topic.

Another big advantage is the reporting system. This system is able to collect all scans of healthcare workers. This data is stored, and can be used in many different ways, for monitoring, trend analysis, scientific experiments or against lawsuits. This is very beneficial, because IPCs can have a clear picture of the hand hygiene status at the given institution any time, and they can suggest training to the individuals not performing well.

Moreover, the data can be exported in a few clicks for reporting and audit purposes. This saves the IPC a lot of time and energy. Moreover, the management can get a real-time overview of the processes across their facility, identify critical areas for development, and arrange proper intervention.

The Semmelweis Scanner is an interactive and user-friendly device. Therefore, it can be used not only by healthcare workers but by visitors as well, by placing the device outside the ward. There are not many hospitals that could effort to dedicate staff to visitor training on patient safety, and our system does the job.

Disinfecting one’s hands properly seems to be easy while in fact, it is not. What exactly is taught during the Hand Hygiene Training offered by HandInScan?

Usually, the issue being with one’s hand disinfection practice is that it is done in a well-accustomed way. Healthcare workers develop a habit of how to perform the WHO 6-step-protocol. The problem is that it is rarely perfect! Most people tend to miss out the same areas every time as they perform their hand disinfection procedure.

With the help of the Semmelweis Scanner, healthcare workers can immediately see the result of their hand rubbing. The device gives prompt, clear and objective feedback on hand hygiene quality. The user can see the coverage straight away, as well as the missed areas. With the help of the reporting system, the user gets personalized feedback, where s/he can track the progress, and even compare each day’s scans. After a while, the user will see the area s/he most frequently missed, and will pay special attention to it. With this, we introduce accountability to hand hygiene. While it is a core component of patient safety, it has rarely been introduced to the general quality processes. This is about to change in the Western world. For example, since last year, the Joint Commission in the USA put hand hygiene into the spotlight of its audits. This critical look on quality is coming to other parts of the world as well, e.g. the official recommendations of the Robert Koch Institute in Germany.