Sustained improvement in hand hygiene compliance using a multi-modal improvement programme at a Swiss multi-site regional hospital

Abstract

Evidence of sustained improvement in hand hygiene compliance at the institutional level is scarce. To assess the impact and sustainability of a hospital-wide improvement programme on hand hygiene compliance of staff. Analysis of trends of hand hygiene compliance for all clinical staff, measured through direct observation by trained observers, within a 450-bed multi-centre teaching hospital in the county of Neuchâtel, Switzerland. Implementation of a multi-modal improvement programme based on the World Health Organization (WHO) strategy, with the goal of reaching overall compliance of at least 80%. The strategy content included increasing access to alcohol hand rub; healthcare worker education; two-month interval compliance measurement; and hospital-wide open communication about ward-level results, point-of-care reminders, communication via a dedicated in-house newsletter and leadership engagement. The implementation phase was followed by a consolidation phase. In total, 33,476 observations were collected from September 2012 to March 2014 (mean >3000 opportunities per audit). Overall compliance improved from 61.4% at baseline to 83.6% after the 18-month improvement programme (P<0.001), and was sustained at 85.3% 18 months later (i.e. 18 months after the programme finished) (P=0.08). The same trend (significant and clinically relevant improvement during the intervention, sustained after 18 months) was measured for all professional categories. This WHO-inspired improvement programme was associated with a significant improvement in hand hygiene compliance, globally and for each professional category. The results were sustained over an 18-month period.