| Principal Investigator: | Concepcion N. Moore, RN, MBA, CIC |
| Co-Principal Investigators/Collaborators: | Georgetta Seidel, Kathryn Ellerson, Anita Crockett (Presenter) |
| Organization: | University Medical Center |
Abstract
Problem
Poor hand hygiene (HH) compliance has been linked to transmission of health care acquired (HCA) pathogens.
Evidence
Baseline data were obtained by assigning a “secret shopper” (an employee outside the infection control department) to collect observations of HH opportunities and compliance among HCWs during patient encounters. These observations revealed poor compliance (55 %). Results were categorized by type of HCWs.
Strategy
Our goal was to improve HH compliance rates among all healthcare workers (HCW) at an academic medical center by applying a systems approach to cultural change in the routine patient care workday.
Practice Change
Baseline data were presented to directors, supervisors, and patient care managers. A house wide presentation was given to staff, including importance of HH, CDC recommendations on HH, unit-specific compliance rates, and hand-sanitizer effectiveness. A campaign was then launched to improve HH compliance to 90%. Infection Control staff members began daily observations on all nursing units, documenting opportunity and compliance rates. HCWs were approached when non-compliance was observed. A gentle reminder approach to “do the right thing for our patients” helped IC staff gain cooperation of HCWs for this cultural change. Additional hand sanitizers were placed in patient rooms, hallways, and staff break rooms. Employees experiencing sensitivities to the existing HH products were referred to Employee Health and given substitute HH products for their use. Staff received routine feedback about their unit-specific HH compliance rates.
Results
Improvement in HH compliance was observed over the 24 months of interventions. Compliance improved for physicians from 56% to 96%, for nursing 71% to 98%, and for patient care technicians from 38% to 93%. Over all compliance for the institution improved from 55% to 97%.
Recommendations
A systems approach can improve HH if it provides HCWs with: 1) An understanding of how lack of HH compliance can contribute to HCA infections; 2) Improved availability of HH products; 3) Gentle reminders to “do the right thing”; 4) Routine feedback on compliance rates; and 5) Make hand hygiene observations a routine part of Infection Control surveillance activities.
Bibliography
- CDC. Guideline for hand hygiene in health-care settings: recommendations of the Health Care Infection Control Practices Advisory Committee and the HIC-PAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51 (no.RR-16): 1–47
- Pittet, D., et al., Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000; 356:1307–12.
- Bischoff, W.E., et al., Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:1017–21