Susan Boeker, BSN, RN, CIC, Infection Control Practitioner, Connie Steed, RN, MSN, CIC, Director of Infection Control, William Kelly, MD, Hospital Epidemiologist, Karen Corwin, CPM, Purchasing Agent, Greenville Hospital System, Greenville, SC.
Issue: Monitoring healthcare worker (HCW's) adherence with recommended hand-hygiene practices is a IA recommendation of the Healthcare Infection Control Practices Advisory Committee. Greenville Hospital System (GHS) is a 1110 bed hospital system spread over five campuses with greater than 7000 employees which can make this a challenging task.
Project: GHS has developed a multi-tiered system to hand hygiene monitoring which includes: direct observation of HCW hand hygiene, hand hygiene product usage, and patient perception of HCW hand hygiene. Direct hand hygiene observation is conducted by frontline workers using a standardized process. HCW's are trained by the Infection Control Practitioner (ICP) in proper monitoring methods. Monitoring is conducted by a wide range of disciplines such as: nursing, respiratory therapy, physical therapy, and security. The data is aggregated and reported on a department, facility, and hospital system level. The results are shared on a quarterly basis. Hand hygiene product usage is monitored on a hospital system level (rate of ounces of hand hygiene product used per 100 adjusted patient days). Patient perception of HCW hand hygiene behaviors is monitored by a patient satisfaction survey sent to a randomized sample of patients treated at the hospital system. Patient perception data is collected for both inpatients and emergency room (ER) visits and aggregated per facility. The results of all monitoring activities are reported to the Infection Control Committee and leadership on a routine basis.
Results: Comparison of fiscal year 2007(FY07) to 2006 (FY06) for direct observation of hand hygiene shows an increase in compliance with cleaning hands before patient care (70.5% FY07, 69.1% FY06, p = 0.12) and a subsequent decrease in cleaning hands after patient care (85.8% FY07, 86.9% FY06,p = 0.14). Product usage showed a statistically significant increase for both hand soap (220.8 FY07, 210.37 FY06, p < 0.001) and alcohol-based hand rub (100.5 FY07, 72.26 FY06, p < 0.001). Patient perception survey findings regarding HCW hand hygiene compliance showed an increase in the score for FY07 compared to FY06 for the three inpatient hospitals surveyed, and for three of the four ER's surveyed within the hospital system.
Lessons Learned: Utilizing a multi-tiered approach gives the organization more than one means of evaluating the effectiveness of their program. Due to the concern for bias by hand hygiene observers and the lack of a statistically significant increase in hand hygiene behavior, a plan to validate direct observation data has been implemented. While patient perception data is not an accurate depiction of hand hygiene compliance, the results give GHS an idea of the impact of the hand hygiene program on patient perception. Because of the bias and perceptions of the other data monitored, product utilization may be more applicable for hand hygiene monitoring. Investigation of the interactions of these patterns is ongoing.
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