Advertisement

Hospital hand hygiene compliance improves with increased monitoring and immediate feedback

      Highlights

      • Here we demonstrate that a novel hand hygiene monitoring program significantly increased hand hygiene compliance.
      • Increased hand hygiene compliance after program implementation was sustained for more than 6 months.
      • Continuous monitoring by salient observers and immediate feedback are imperative for a successful hand hygiene program.

      Background

      Health care–associated infections are serious complications impacting 2 million patients and accounting for approximately 100,000 deaths per year. In the present study, we evaluated the effectiveness of a new hand hygiene monitoring program (HHMP) and measured the sustainability of this effectiveness over a 1-year period.

      Methods

      The HHMP consisted of 4 key components: extensive education, conspicuous and visible monitors, immediate feedback concerning compliance to health care workers, and real-time data dissemination to leadership. The HHMP was implemented in 2 hospital care units. Two different, but similar, departments served as controls, and hand hygiene compliance was monitored via the “secret shopper” technique. All 4 departments were followed for 12 months.

      Results

      Both experimental departments showed statistically significant increases in hand hygiene compliance. Experimental department 1 increased compliance from 49% to an average of 90%, and experimental department 2 increased compliance from 60% to an average of 96%. Both experimental departments were able to sustain these results for at least 6 months. Compliance rates were significantly higher in the experimental departments compared with the control departments. No significant changes were seen in the control departments.

      Conclusions

      These finding suggest that continuous monitoring by salient observers and immediate feedback are critical to the success of hand hygiene programs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Klevens R.M.
        • Edwards J.R.
        • Richards Jr., C.
        • Horan T.C.
        • Gaynes R.P.
        • Pollock D.A.
        • et al.
        Estimating health care–associated infections and deaths in US hospitals, 2002.
        Public Health Rep. 2007; 122: 1606
        • Allegranzi B.
        • Pittet D.
        Role of hand hygiene in healthcare-associated infection prevention.
        J Hosp Infect. 2009; 73: 305-315
      1. World Health Organization. WHO Guidelines on hand hygiene in health care: first Global Patient Safety Challenge. 2009. Available from: www.who.int/gpsc/country_work/en/. Accessed January 13, 2014.

      2. Centers for Disease Control and Prevention. Hand hygiene in health care settings: hand hygiene basics. Available from: http://www.cdc.gov/handhygiene/Basics.html. Accessed January 13, 2014.

        • Langston M.
        Effects of peer monitoring and peer feedback on hand hygiene in surgical intensive care unit and step-down units.
        J Nurs Care Qual. 2011; 26: 49-53
        • McGuckin M.
        Hand hygiene compliance rates in the United States: a 1-year multicenter collaboration using product/volume usage measurements and feedback.
        Am J Med Qual. 2009; 24: 205-213
        • Pittet D.
        Compliance with hand disinfection and its impact on hospital-acquired infections.
        J Hosp Infect. 2001; 48: 540-546
      3. O'Reilly K. Patient safety surveillance: keeping watch in hospitals, from sinks to surgery. Available from: http://www.amednews.com/article/20091130/profession/311309980/2/. Accessed May 16, 2014.

        • Homa K.
        • Kirkland K.
        Determining next steps in a hand hygiene improvement initiative by examining variation in hand hygiene compliance rates.
        Qual Manag Health Care. 2011; 20: 116-121
        • Nevo I.
        • Fitzpatrick M.
        • Thomas R.
        • Gluck P.
        • Lenchus J.
        • Arheart K.
        • et al.
        The efficacy of visual cues to improve hand hygiene compliance.
        Simul Healthc. 2010; 5: 325-331
        • Overby J.
        • Good B.
        Hand hygiene-national patient safety goal 7A: a program to improve compliance.
        Oncol Nurs Forum. 2008; 35: 517
        • Pincock T.
        • Bernstein P.
        • Warthman S.
        • Holst E.
        Bundling hand hygiene interventions and measurements to decrease health care–associated infections.
        Am J Infect Control. 2012; 40: S18-S27
        • Boyce J.M.
        Hand hygiene compliance monitoring: current perspectives from the USA.
        J Hosp Infect. 2008; 70: 2-7
        • Larson E.
        • Aiello A.
        • Cimiotti J.
        Assessing nurses' hand hygiene practices by direct observation or self report.
        J Nurs Meas. 2004; 12: 77-85
      4. Cooper LM, Oden MA, Elliott BK, Harger JA, Anderson DJ. Increased hand hygiene observations add validity to infection control data: but how to achieve in a busy hospital world? Poster presented at the Fifth Decennial Conference on Healthcare-Associated Infections, Atlanta, GA, March 19, 2010.

        • Joint Commission
        Measuring hand hygiene adherence: overcoming the challenges.
        Joint Commission, Oakbrook Terrace [IL]2009
        • Cribari-Neto F.
        • Zeileis A.
        Beta regression in R.
        J Stat Softw. 2010; 34: 1-24
        • World Health Organization
        WHO guidelines for hand hygiene in health care.
        World Health Organization, Geneva, Switzerland2009
        • Haynes S.
        • Horn W.
        Reactivity in behavioral observation: a review.
        Behav Assess. 1982; 4: 369-385
        • Rosenthal T.
        • Erbeznik M.
        • Padilla T.
        • Zaroda T.
        • Nguyen D.
        • Rodriguez M.
        Observation and measurement of hand hygiene and patient identification improve compliance with patient safety practices.
        Acad Med. 2009; 84: 1705-1712
        • Tibballs J.
        Teaching hospital medical staff to handwash.
        Med J Aust. 1996; 164: 395-398
        • Talbot T.R.
        • Johnson J.G.
        • Pergus C.
        • Domenico J.H.
        • Schaffner W.
        • Daniels T.L.
        • et al.
        Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives.
        Infect Control Hosp Epidemiol. 2013; 34: 1129-1136
        • Pittet D.
        • Dharan S.
        • Touveneau S.
        • Sauvan V.
        • Perneger T.V.
        Bacterial contamination of the hands of the hospital staff during routine patient care.
        Arch Intern Med. 1999; 159: 821-826
        • MacDonald A.
        • Dinah F.
        • MacKenzie D.
        • Wilson A.
        Performance feedback of hand hygiene using alcohol gel as the skin decontaminant reduces the number of inpatients newly affected by MRSA and antibiotic costs.
        J Hosp Infect. 2004; 56: 56-63
        • Rosenthal V.D.
        • Guzman S.
        • Safdar N.
        Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.
        Am J Infect Contr. 2005; 33: 392-397
        • Conly J.M.
        • Hill S.
        • Ross J.
        • Lertzman J.
        • Louie T.J.
        Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.
        Am J Infect Control. 1989; 17: 330-339
        • Simmons B.
        • Bryant J.
        • Neiman K.
        • Spencer L.
        • Arheart K.
        The role of handwashing in prevention of endemic intensive care unit infections.
        Infect Control Hosp Epidemiol. 1990; 11: 589-594
        • Lederer Jr., J.W.
        • Best D.
        • Hendrix V.
        A comprehensive hand hygiene approach to reducing MRSA health care–associated infections.
        Jt Comm J Qual Patient Saf. 2009; 35: 180-185
        • Lam B.C.
        • Lee J.
        • Lau Y.L.
        Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection.
        Pediatrics. 2004; 114: e565-e571
        • Won S.P.
        • Chou H.C.
        • Hsieh W.S.
        • Chen C.Y.
        • Huang S.M.
        • Tsou K.I.
        • et al.
        Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2004; 25: 742-746
        • Marra A.
        • Moura D.
        • Paes A.
        • Oscar F.
        • Edmond M.
        Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices.
        Infect Control Hosp Epidemiol. 2010; 31: 796-801
        • Scheithauer S.
        • Haefner H.
        • Schwanz T.
        • Schulze-Steinen H.
        • Schiefer J.
        • Koch A.
        • et al.
        Compliance with hand hygiene on surgical, medical, and neurologic intensive care units; direct observation versus calculated disinfectant usage.
        Am J Infect Control. 2009; 37: 835-841
        • Morgan D.
        • Pineles L.
        • Shardell M.
        • Young A.
        • Ellingson K.
        • Jernigan J.A.
        • et al.
        Automated hand hygiene count devices may better measure compliance than human observation.
        Am J Infect Control. 2012; 40: 955-959
        • Armellino D.
        • Hussain E.
        • Schilling M.E.
        • Senicola W.
        • Eichorn A.
        • Dlugacz Y.
        • et al.
        Using high technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare.
        Clin Infect Dis. 2012; 54: 1-7