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James Lankford. Successful feedback needs to be timely, specific, and focus on the actions or behavior that is observed. IPs could perform informal surveys of staff perceptions of hand hygiene in this time and use that information to help find the reasons why people are doing the right thing.

They can also use that knowledge to develop campaigns and materials that will continue to encourage positive change.

In the past, when there have been major national health threats, such as anthrax attacks and Ebola, the federal government earmarked funding for grants and programs that would be used for public health efforts or for hospitals to obtain training or personnel to focus on preparedness efforts.

If funding becomes available for healthcare facilities as a result of increased government grants or programs, it would be ideal to use some of those funds to invest in technology that would improve hand hygiene compliance, such as the electronic monitoring systems.

Another option is telemedicine, using electronic communication to decrease the number of times staff have to come in and out of the patient rooms, therefore removing one of the known barriers to hand hygiene compliance.

But ultimately technology cannot solve all the barriers for hand hygiene compliance and, to truly have sustained change, a cultural shift must occur within the facility.

Role modeling, timely feedback, consistent monitoring, and data reports all help support the clean hands culture that is needed in healthcare facilities.

At this time, months into the COVID pandemic, some of the behavior change will start to normalize. Before habits return to pre-COVID ways, IPs have the opportunity to build on the renewed importance of hand hygiene in healthcare and start to build the foundations of a new hand hygiene campaign in their facilities.

Leadership involvement is key, as well as finding those informal leaders in the unit level who can be local champions and the role models needed to help drive overall behavior.

The core of much of what an IP does requires them to become change agents. A strong change agent needs to be curious, persistent, and collaborative.

There are many examples of research on how to influence behavior change and how to utilize some of the informal leaders, social pressure, and feedback to create that culture shift within an organization.

An IP does not receive formal education on behavior change science, but it would be beneficial to seek out some of these resources and perhaps work with local and national professional organizations to offer course work, online classes and other avenues to include these topics into the IP trainings.

Behavior change during a pandemic is related to several factors: risk assessment, personal fears, social factors, informational campaigns, and cultural expectations.

Also, patients are more acutely aware of the role of hand hygiene in a pandemic and are another source of social pressure to perform.

Hand hygiene has always been the most common way that IPs have talked about preventing the spread of infection, and that has been true with COVID The first item listed on the US Centers for Disease Control and Prevention CDC website on how to prevent the spread is hand hygiene and it has been consistently educated to the public.

One challenge to understanding how hand hygiene habits changed in healthcare during COVID is the ability to accurately measure and report compliance data.

Hand hygiene is most typically monitored via secret shopper observations. During times of pandemics, the staff who would typically be doing these observations, such as nursing supervisors, ancillary staff, and infection preventionists may be pulled into other duties or not available.

Monitoring and observing for hand hygiene may not be a top priority when other patient care concerns are paramount. Also, secret shopper observations have an inherent flaw in observational bias and Hawthorne effect, which have been recognized as a well-known shortcoming of data reported using that type of data collection.

These limitations create a gap in knowledge to understand whether compliance increased or whether that is a perception or assumption.

Healthcare facilities have struggled with achieving and sustaining high compliance rates of hand hygiene, despite the awareness and knowledge of its importance for centuries.

Semmelweis was the first hand hygiene champion in , and was met with disdain at first, eventually gaining some acceptance before being sent to a mental institution.

Electronic hand hygiene monitoring systems have been shown to provide more reliable data and also can improve compliance rates.

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Post Hand Video

Vlog - Guitar player post hand surgery