Increasing Employee Hand Hygiene Compliance: A Patient Safety Goal

ISSUE: In 2003 healthcare worker hand hygiene became a patient safety goal. In October 2003 the Greenwich Hospital/Yale New Haven Health System Quality Management selected employee compliance with hand hygiene as a quality core measure. Employee compliance with the hand hygiene guidelines was 58% at the start of the initiative. Employees were inconsistent with their hand hygiene practices, had unrealistic perceptions of hand hygiene compliance, failed to recognize the risk to the patient, and were unaware of the hand hygiene policy. In addition a number of barriers to hand hygiene were identified, including sinks blocked by furniture and patient possessions, staff too busy to wash their hands, and the unavailablity of sinks.

PROJECT: A Process Improvement Team was formed to address the issues identified, and to improve employee hand hygiene compliance. Improvement strategies included, in-service education with the staff, the distribution of the patient safety goals and the hand hygiene policy and procedure, signage and flyers that emphasized hand hygiene, a newsletter article on hand hygiene, placement of alcohol sanitizer dispensers in areas where sinks were unavailable, as well as in all clinical departments; in all nursing stations, on medication carts, isolation carts, every patient room, and throughout the hospital. Pocket-sized bottles of sanitizer were also available for staff and physicians. A team of hand hygiene monitors trained on observations, documentation and the hand hygiene policy observed employees for compliance with the policy.

A compliance scorecard by department and profession was provided to the managers, department heads and the chief of the medical staff. In addition the non-compliant employees received a memo reiterating the hospitals committment to patient safety and the potential consequences of their behavior.

RESULTS: In December 2003 the employee hand hygiene compliance was 58% (baseline data).

Employee hand hygiene compliance increased from 59% in the 1st Q of fiscal year 2004 to 86% in the 1st Q of fiscal 2005.

LESSONS LEARNED: The two most significant factors for increasing hand hygiene compliance among staff was the regular feedback to the individual employee about their hand hygiene practices and the department and nursing unit specific scorecard.

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