Helen S. Brom, RN, BSN, Infection Control/Employee Health Coordinator, Dori Henderson, PhD, Staff Development Coordinator, Shriners Hospitals for Children/Twin Cities, Minneapolis, MN.
Issue: Reducing health care acquired infections should be the responsibility and goal of every hospital employee. We believe that no infections should be perceived as acceptable. Even though our hospital's infection rate is considered low compared with national standards, until we reach zero, there is always room for improvement.
Project: The purpose of this presentation is to describe a program for monitoring staff hand hygiene activity at a small orthopaedic pediatric hospital in the Midwest. Our project had two goals. The first was to measure staff hand hygiene compliance. The second was to establish a convenient way to measure ongoing hand hygiene activity and evaluate its impact on our hospital's infection rate. The data will be used to identify and plan infection control improvement opportunities and provide a baseline against which to evaluate the effectiveness of those future improvements.
To achieve our first goal we conducted a two week covert observational study of hand hygiene compliance. During that time the hand hygiene activity of staff in eight hospital areas was monitored by trained secret observers. The tool (IHI Hand Hygiene and Glove Use Monitoring Form) and methods used to measure hand hygiene compliance were sanctioned by the CDC.
To achieve our second goal we began (in January of 2007) to measure the monthly volumes of soap and hand sanitizer use in ounces per 1,000 patient-days, according to Joint Commission and CDC recommendations. Our assumption was that hand sanitizer and soap usage reflects hand hygiene activity among staff. We then correlated these measures of hand hygiene activity with our monthly infection rates, normalized for patient activity (i.e., number of infections per 1000 patient days).
Results:
Hand hygiene compliance: Across the two week monitoring period trained observers evaluated 176 hand hygiene encounters. Our covert study revealed an average compliance of 65.9% ± 26.5 (sd) across eight areas of the hospital (range: 11.1% to 100%). Additional data, qualitative (observer comments) and quantitative, suggested that failure to comply with hand hygiene guidelines was often due to a failure to clean hands prior to performing patient care.
A method for evaluating ongoing hand hygiene activity and its impact on hospital infection rates: In January of 2007 we began monitoring soap and hand sanitizer use as indicators of hand hygiene activity. A scatter plot of hand hygiene activity vs. monthly infection rate suggested the two were inversely related.
Lessons learned:
1)Our overall hand hygiene compliance was higher than that estimated by the Institute for Healthcare Improvement. However, our data revealed that 34% of hand hygiene opportunities were unsuccessful. By evaluating different areas within the hospital we were able to learn which departments were in need of additional monitoring and follow-up education. The Hand Hygiene and Glove Use Monitoring Form allowed us to identify the specific changes necessary to improve compliance.
2)Using monthly soap and hand sanitizer volumes proved to be a convenient means of evaluating ongoing staff hand hygiene activity. To date, the data suggest that as soap/hand sanitizer use increases, infection rates diminish.
3)We presented our methods and data to hospital staff, administrators, board members and a Joint Commission surveyor. All received the information with great enthusiasm and were pleased with our quantitative approach.
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