Return on investment (ROI) is the largest parameter that any measure taken must meet in order to convince the decision maker.
Even in a public health system as our NHS (SNS in spanish) ROI should be used to prioritize policies to establish or strengthen.
But, what is the ROI of hand washing? No one disputes that the proper practice of hand washing is a professional obligation more than a good practice, but this obligation is diluted in the daily work and this is where the investment and ROI come in action.
Recently I came to a highly recommended publication of the JCI "MEASURING HAND HYGIENE ADHERENCE: OVERCOMING THE CHALLENGES" (.PDF 4,6 Mb) thanks to the blog of SNS quality plan.
This publication explains that the measure of adherence to hand washing presents difficulties that lead managers to underestimate their importance because obtaining reliable results by direct observation is a practice "expensive"...and I think .. "expensive"? Expensive are the antibiotics of the third or fourth generation, expensive is every day that a patient stays in the hospital, dearly is human suffering ...
But it is also true that to measure is not to improve and to stay on the crest of the wave is more difficult to get on it once. The greater effort every day, is about ourselves and lead by example, especially to training staff to prevent the acquisition of erroneous beliefs as say that the antibiotics are the best prevention.
When i acquired my little knowledge about quality i quickly realized that in healthcare the "non-quality costs" even remain invisible have a high weight in the final result of our work; so we know that as important as research and innovate in new products is innovate and research to eliminate beliefs and behaviors that produce low quality results.
Nurses should have its goals focused towards quality, a goal is an achievement whose result largely depends on the profesional who does the work and can be improved by acting on their knowledge or their actions independently; so I have no doubt that measuring and improving adherence to hand washing is a clear objective and manageable by the nurse, whose realization requires cost of training in the short, medium and long term, but which prove ROI more problematic to define.
The practical guide for preventing hospital-acquired infections published by the WHO (I have the 2003 edition, but surely there is an update) indicates as a responsibility of the nurse ward chief monitor aseptic techniques, including handwashing and isolation. But responsibility must entail a dual capacity: on one side of the example and on the other side the authority, that both capacities are met should be charged the next higher instance.
Thus the investment and the goal it seems clear . What is your ROI? To say that the disappearance of hospital-acquired infections is to score a target more than difficult, since many of these infections will be due to patient's own immune status; quantify how many of these infections are due to poor hand washing or its absence is a statistical enterprise that is necessary to have local data (Data that only can be achieved by training who must to take it and the time to take it). But is the way, that and determine what is the cost of such infections. In the hospital's own data from is your assessment; How much is a day of hospitalization? How much does treatment with certain antibiotics? Put this on a scale seems simple, but it is not and leaves out other costs "Intangibles" but most appreciated for people.
Please forgive my poor expression on english, i'm trying to improve.