Give Less Than 100% to Reduce HAIs

Eighty-five percent is the new 100 percent, according to recent articles in the Wall Street Journal and Becker’s Hospital Review

The so-called 85% rule posits that organizations will see better results if they don’t strive for perfection. Advocates — including the actor Hugh Jackman — note that it’s impossible to sustain 100% effort over the long term. 

Science also proves that perfection is not necessary for advancement toward goals. Researchers published the “Eighty Five Percent Rule for Optimal Learning” in Nature Communications in 2019 after discovering that people, animals, and artificial neural networks gain knowledge most quickly when they train at a level where they consistently achieve 85% accuracy.  

The 85% rule can help you decrease healthcare association infections (HAIs), too. Here’s how: 

100% Hand Hygiene Compliance Isn’t Realistic

One hundred percent hand hygiene compliance isn’t practical. If a patient is actively hemorrhaging, a physician will react to stop the bleeding. When a patient experiences cardiac or respiratory arrest, the healthcare team initiates life-saving measures ASAP. 

Perfection is impossible in a dynamic environment characterized by evolving demands and ever-shifting resources. The Joint Commission acknowledged that fact in 2010, dropping an infection control standard that called for more than 90% hand hygiene compliance after studies revealed that highly motivated hospitals didn’t hit 90% compliance, even with great effort.

Although those hospitals fell short of the goal, healthcare-associated infections (HAIs) declined. In response, the Joint Commission amended its standard; hospitals are now expected to improve hand hygiene compliance, rather than required to hit specific targets. 

The COVID-19 pandemic underscored the impracticality of striving for perfection amid less-than-perfect conditions. Although many hospitals saw a dramatic increase in hand hygiene compliance in the early days of the pandemic — with some hospitals and units hitting compliance levels greater than 90% — no hospital was able to sustain that level of hand hygiene. 

By August of 2020, hand hygiene compliance at the University of Chicago Medical Center was down to 56%, even though many units in the hospital had achieved 100% compliance during the last week of March 2020. As the authors of a 2023 article about healthcare personnel hand hygiene compliance wrote, “high compliance is possible, yet difficult to sustain.”

Aiming for 100% Increases Burnout

Striving for 100% can lead to exhaustion and burnout. Today’s healthcare workers are frequently working short-staffed. They’re doing the best they can under difficult circumstances. Constantly expecting them to do better – without providing additional resources – is not reasonable. Workers who are already giving their all begin to shut down when asked to do more. 

Human beings are simply not capable of maintaining peak performance indefinitely. Expecting perfection and calling out employees’ lack of success in achieving it is often counterproductive. The link between impossible standards and burnout should not be ignored at a time when widespread nurse shortages are impacting hospitals’ ability to provide patient care. 

Setting modest, achievable goals is more likely to lead to sustainable positive change. SwipeSense can help healthcare facilities determine their baseline hand hygiene rates, establish realistic goals, and gradually shift workflows and behaviors to achieve those goals.   

HAIs Decrease with Modest Improvements in Hand Hygiene

In 2021, researchers conducted a systematic review of the published literature to determine an optimal threshold for hand hygiene compliance in healthcare settings. They wanted to know what compliance rate was associated with the lowest HAI incidence rate – and discovered that lower HAI incidence rates were achieved with hand hygiene compliance rates of approximately 60%. 

Connie Steed, MSN, RN, CIC, FAPIC, an infection prevention consultant and past president of the Association of Professionals in Infection Control and Epidemiology (APIC), recently acknowledged that “there is not a clear answer” to the question of what level of hand hygiene compliance is necessary to improve patient outcomes. 

She described a recent study that demonstrated a reduction in MRSA infection on hospital units with improved hand hygiene compliance, noting that hand hygiene rates on those units were “not 90%,” but 65-70%. 

“There needs to be more study to clarify what the [hand hygiene compliance] standard should be, but it’s clear that you do have improvement in reducing infections without it being 100%,” Steed said.

Research suggests that aiming for 85% hand hygiene compliance can lead to sustainable improvement and decreased HAIs. Learn more about how SwipeSense can help you improve hand hygiene performance and decrease HAIs.