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Q&A : The Joint Commission's Melody Dickerson

by Brendon Nafziger, DOTmed News Associate Editor | October 15, 2010
The Joint Commision's
Melody F. Dickerson
The Joint Commission hopes an interactive online tool will help hospitals fight one of health care's dirtiest problems: hand-washing.

Launched last month, the Targeted Solution Tool, available at no cost to Joint Commission-accredited institutions, could help hospitals track and improve hand-washing compliance.

While it appears simple on its face, achieving hand-washing compliance has been devilishly tricky in practice. In fact, some estimate that people in public bathrooms are more likely to wash their hands than health care providers - a survey last month found around 85 percent of public bathroom users washed up afterward. But only between a quarter and one-third of health care professionals followed proper hand hygiene protocols, according to a 2009 American Journal of Medical Quality report.

"[T]he guy who just used the toilet at Grand Central Station is...way more likely to have clean hands than the guy walking up to your bed at the local hospital," Michael L. Millenson wrote last month in the Health Care Blog.

Of course, lack of hand-washing has consequences, such as helping to spread disease. And the scale of health care-acquired infections is immense. In a talk last year, The Joint Commission president Dr. Mark Chassin said the number of deaths in the United States every year from health care-associated infections was the mortality equivalent of a 767 crashing and killing everyone on board, every day of the year.

Looking for answers

Last year, The Joint Commission launched the Joint Commission Center for Transforming Healthcare, to solve health care safety and quality problems. One of the fruits of this work is the Targeted Solutions Tool, an online application accessible for TJC-accredited hospitals (via their extranet account).

From feedback from the first eight hospitals involved in the program, the commission decided hand hygiene would be the first target (a set of solutions for hand-off communications will be announced next week and solutions to prevent wrong-site surgery are expected to be released this spring).

The tool works like this: some staff are picked to be observers and report on the hand hygiene performance of their coworkers. They either input their reports directly into a computer or jot it down on a printout and later feed it into the website.

The tool then creates a confidential report so hospitals can track their hygiene and find out weaknesses they can improve upon. And results come quickly, TJC says. The whole process takes about six to 12 weeks.