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The Power of Feedback: Implementing a Comprehensive Hand Hygiene Observer Program

      Highlights

      • Overt observations and timely feedback provide reliable and efficient HH monitoring
      • Observer visibility allows for dialogue around the observation process and HH moments
      • Transparency around observer presence encourages dialogue around improvement
      • Leadership engagement strengthened relationship between HH observers and clinicians

      Abstract

      Background

      : Hand hygiene (HH) is a fundamental component of infection prevention within all healthcare settings. We implemented a hospital-wide program built on overt HH observation, real-time feedback, and thematic analysis of HH misses.

      Methods

      : A robust observer training program was established to include foundational training in the WHO's My Five Moments of Hand Hygiene. Observational data from 2011-2019 were analyzed by unit, provider type, and thematic analyses of misses.

      Results

      : During the study period, we conducted 160,917 hospital-wide observations on 29 units (monthly average of 1490 observations). Institutional compliance remained above 95% from 2013 to 2019. Thematic analysis revealed “touching self” and “touching phone” as common, institution-wide reasons for HH misses.

      Discussion

      : Overt observations facilitated communication between HH program and healthcare staff to better understand workflow and educate staff on HH opportunities. This program is an integral part of the Infection Prevention team and has been deployed to collect supplemental data during clusters and outbreaks investigations.

      Conclusion

      : In addition to having rich HH data, successes of this program, include increased awareness of IPC practices, enhanced communication about patient safety, enriched dialog and feedback around HH misses, and relationship building among program observers, unit staff and leaders.

      Keywords

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      References

        • Mathur P.
        Hand hygiene: back to the basics of infection control.
        Indian J Med Res. 2011 Nov; 134: 611-620https://doi.org/10.4103/0971-5916.90985
        • You E
        • Ursua L
        • Clark R
        • Seok J
        • Jeon J
        • Kim HB.
        The effect of incorporating covert observation into established overt observation-based hand hygiene promotion programs.
        Am J Infect Control. 2019 May; 47: 482-486https://doi.org/10.1016/j.ajic.2018.11.002
        • Lehotsky Á
        • Szilágyi L
        • Ferenci T
        • Kovács L
        • Pethes R
        • Wéber G
        • Haidegger T.
        Quantitative impact of direct, personal feedback on hand hygiene technique.
        J Hosp Infect. 2015 Sep; 91: 81-84https://doi.org/10.1016/j.jhin.2015.05.010
        • Ward MA
        • Schweizer ML
        • Polgreen PM
        • Gupta K
        • Reisinger HS
        • Perencevich EN.
        Automated and electronically assisted hand hygiene monitoring systems: a systematic review.
        Am J Infect Control. 2014 May; 42: 472-478https://doi.org/10.1016/j.ajic.2014.01.002
        • Sax H
        • Allegranzi B
        • Uçkay I
        • Larson E
        • Boyce J
        • Pittet D.
        My five moments for hand hygiene': a user-centered design approach to understand, train, monitor and report hand hygiene.
        J Hosp Infect. 2007 Sep; 67: 9-21https://doi.org/10.1016/j.jhin.2007.06.004
        • Kwok YL
        • Gralton J
        • McLaws ML.
        Face touching: a frequent habit that has implications for hand hygiene.
        Am J Infect Control. 2015 Feb; 43: 112-114https://doi.org/10.1016/j.ajic.2014.10.015
        • Pal S
        • Juyal D
        • Adekhandi S
        • Sharma M
        • Prakash R
        • Sharma N
        • et al.
        Mobile phones: Reservoirs for the transmission of nosocomial pathogens.
        Adv Biomed Res. 2015 Jul 27; 4: 144https://doi.org/10.4103/2277-9175.161553
        • Krediet AC
        • Kalkman CJ
        • Bonten MJ
        • Gigengack AC
        • Barach P.
        Hand-hygiene practices in the operating theatre: an observational study.
        Br J Anaesth. 2011 Oct; 107: 553-558https://doi.org/10.1093/bja/aer162
        • Megeus V
        • Nilsson K
        • Karlsson J
        • Eriksson BI
        • Andersson AE.
        Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room.
        Antimicrob Resist Infect Control. 2015 Feb 6; 4: 5https://doi.org/10.1186/s13756-015-0042-y
        • Nomides N
        • Sweeney J
        • Yee M
        • Washer L
        • Murphy S
        • Valyko A
        • et al.
        Hand Hygiene in the Operating Room: The Final Frontier.
        Am J Infect Control. 2017 Jun1; 45: S102-S103https://doi.org/10.1016/j.ajic.2017.04.164
        • Pedersen L
        • Elgin K
        • Peace B
        • Masroor N
        • Doll M
        • Sanogo K
        • Zuelzer W
        • Peterson G
        • Stevens MP
        • Bearman G.
        Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite.
        Am J Infect Control. 2017 Jun 1; 45: 695-697https://doi.org/10.1016/j.ajic.2017.01.003
        • Scheithauer S
        • Oude-Aost J
        • Heimann K
        • Haefner H
        • Schwanz T
        • Waitschies B
        • Kampf G
        • Orlikowsky T
        • Lemmen SW.
        Hand hygiene in pediatric and neonatal intensive care unit patients: daily opportunities and indication- and profession-specific analyses of compliance.
        Am J Infect Control. 2011 Nov; 39: 732-737https://doi.org/10.1016/j.ajic.2010.12.020
        • Mukerji A
        • Narciso J
        • Moore C
        • McGeer A
        • Kelly E
        • Shah V.
        An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes.
        BMJ Open. 2013 May 28; 3e003018https://doi.org/10.1136/bmjopen-2013-003018
        • Wolfe JD
        • Domenico HJ
        • Hickson GB
        • Wang D
        • Dubree M
        • Feistritzer N
        • et al.
        Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance.
        J Patient Saf. 2018 Apr 20; https://doi.org/10.1097/PTS.0000000000000488
        • Kirkland KB
        • Homa KA
        • Lasky RA
        • Ptak JA
        • Taylor EA
        • Splaine ME.
        Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series.
        BMJ Qual Saf. 2012 Dec; 21: 1019-1026https://doi.org/10.1136/bmjqs-2012-000800
        • Fries J
        • Segre AM
        • Thomas G
        • Herman T
        • Ellingson K
        • Polgreen PM.
        Monitoring hand hygiene via human observers: how should we be sampling?.
        Infect Control Hosp Epidemiol. 2012 Jul; 33: 689-695https://doi.org/10.1086/666346