Marla Clifton, RN, MSN, CIC, Infection Control Practitioner, Jewish Hospital, Cincinnati, OH.
Issue: Hand hygiene is one of the most significant means of reducing hospital-associated infections. It's a simple, easy, inexpensive way to ensure patient and health care worker safety. Hand hygiene serves as the basic foundation for all infection prevention and control practices. In order to assess compliance with hand hygiene practices throughout the hospital, a hand hygiene observation tool was developed and implemented in December 2003.
Project: In December 2003, a hand hygiene observation process and tool was implemented. The process is as follows: Observations are conducted “discreetly” by the Patient Safety Leaders. All health care workers, including physicians, are observed. Observations are conducted at random times. Each Patient Safety Leader (PSL) conducts at least 15-20 observations per month. Observations are documented on the Hand Hygiene Standards and Survey Tool. If hand hygiene infraction is observed, the associate is informed immediately and discreetly. The department manager and Infection Control Practitioner (ICP) review completed surveys for accuracy. The ICP tabulates the data and reports the findings to multiple hospital committees and department managers. Recommendations and plans for improvement are developed house-wide and in departments based on the findings. Follow-up is documented in committee/department minutes.
Results: We have sustained improvement in our hand hygiene initiative overall since its initiation. Baseline compliance was 69% in December 2003. Hand hygiene compliance improved steadily with 74% overall compliance achieved in 2004, 89% in 2005, 92% in 2006 and 94% for January-September 2007. Compliance scores are stratified by health care worker type and by department. This analysis assists leadership in targeting areas for action plans.
Hand hygiene is an important component of the infection prevention care bundles that have been implemented in the Intensive Care Unit (ICU). A corresponding 69% reduction in ventilator-associated pneumonias (VAP), 100% reduction in catheter-associated bloodstream infections (CA-BSI), and 41% reduction in catheter-associated urinary tract infections (CA-UTI) have been noted in conjunction with the initiation of hand hygiene observations.
Hand hygiene is advocated in the reduction of multi-drug resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA). Even though there has been an increase in the number of hospital MRSA isolates, hospital-associated MRSA infections related to surgical site infections and device-associated ICU infections have not demonstrated an increase. Actually year to date, only one MRSA surgical site infection has been reported and one MRSA ventilator-associated pneumonia in the ICU.
The hospital's Hand Hygiene Guidelines policy prohibits artificial fingernails. Since implementation of the Hand Hygiene Guidelines policy in 2003, department managers have reported ten associates who required follow-up related to artificial fingernails. Follow-up education sessions are provided at the PSL monthly meetings to answer questions or concerns that may arise.
Lessons Learned: Our future efforts will continue monitoring hand hygiene but focus on specific categories of healthcare workers with documented opportunities for improvement. We plan to increase evening and night shift hand hygiene observations.
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