Improving Visitors’ Hand Hygiene Compliance in a Pediatric Oncology Unit

Abstract

BACKGROUND Hand Hygiene (HH) is the most important method to prevent spread of healthcare associated infections. Parents, family and visitors (PFV) are integral partners with the healthcare team for optimal patient outcomes. We aim at improving HH compliance by PFV upon entering a pediatric oncology inpatient unit. METHODS A performance improvement project implemented several interventions between July and November 2018 in Plan-Do-Study-Act (PDSA) cycles that included baseline data collection phase where a wall-mounted alcohol-based hand gel dispenser was available next to the unit entrance, Cycle1 (HH station and poster just facing the entrance as a visual cue), Cycle2 (visual cue + PFV symptom screen as verbal reminder of infections, without HH instructions), and Cycle3 (visual cue + verbal PFV symptom screen + HH verbal instructions). Pre-defined paper observation tool and scripts for symptom screening and HH, in English and Spanish, were used by patient care associates (PCA) who were positioned at the unit entrance reception desk between 07:00 and 23:00. Percent HH compliance was calculated for each cycle. Only observations with complete documentation were included in the analysis. A goal of 90% compliance by December 31, 2018 was set. The participating PCAs were surveyed regarding process feasibility and sustainability. RESULTS Of 1272 observed visitors, 76% were adults, 14% children, and 7% adolescents. Of 955 (75%) observations with complete documentation, 204 were baseline, 293 Cycle1, 330 Cycle2, but it decreased to 128 observations for Cycle3. The percent HH compliance increased from 5% at baseline, to 16% in Cycle1, 21% Cycle2, and 65% Cycle3. CONCLUSIONS A multimodal performance improvement project improved PFV HH compliance. Direct verbal instructions for HH?was the most effective, but less efficient as suggested by?the?decreased number of Cycle3 complete observations. The PCA survey results will help develop a plan for process sustainability.