HH Compliance Research Articles

Near Real-Time Electronic Feedback to Improve Hand Hygiene Adherence

35%. The second unit has shown a 10.51% increase in “Always” response since installation along with 54% increase in dispensing, an 89% increase in HH compliance and a 22% decrease in NIMs. The 2013 savings in NIM for the combined units was $46,150 in direct cost, $31,954 loss and 52.4 days avoided. CONCLUSIONS: Hospital leaders leveraged the electronic messaging capabilities provided in this automated hand hygiene monitoring system to improve hand hygiene performance and positively affect patient perception of caregiver behavior. The survey tool measurement reflected the increased patient satisfaction and the increased HH compliance reduced costs associated with infections.

O016: Electronic hand hygiene monitoring for the WHO 5-moments method

to 71%, while actual HH compliance from video-surveillance ranged from 66 to 75%. Correlation of the latter two metrics was extremely high (r = 0.976, p=0.004). The number of HHOs with the In/Out method (2886) was 36% lower than with the 5-Moments method (4522). Conclusion This study validates the HOW2 Benchmark Study algorithm. It also documents a 36% deficit in HHOs using the In/Out method and a ~30% Hawthorne Effect due to direct observation. There is an extremely high correlation between actual video-taped HH compliance and the electronic monitoring system’s HHCI. We believe that electronic monitoring using the 5-Moments method provides the most accurate and actionable HH compliance data.

P117: Hand hygiene compliance in intensive care units in the Madrid region

HH compliance rates are universally low, leading to unacceptably high rates of healthcare associated infections (HAI). Sice 2010, the Madrid Regional Healthcare System has implemented a regional strategy to improve HH compliance, following the WHO multimodal strategy. HAI rates are especially high in intensive care units (ICU); therefore an effort should be made to evaluate the HH compliance in these units.

Reconsidering Hand Hygiene Monitoring

Observations are also generally limited to work shifts when a full complement of personnel is available for administrative tasks (ie, daytime). Further, the direct observation strategy for measuring HH compliance has long been limited by the “Hawthorne effect,” which refers to a change in behavior that results from the direct visualization of activities. Anecdotally, virtually every healthcare epidemiologist can almost certainly retell a conversation in which an HCW recounted performing HH only when observers were present and conducting compliance audits. Though many organizations attempt to mitigate this effect by using unknown, nonstaff, volunteer, or other types of “secret” observers, over time most individuals working in patient care units will be able to determine the purpose of any person not usually identified as being part of the patient care environment. Implementation of electronic moni

Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomised trial

BackgroundImproving hand hygiene compliance is still a major challenge for most hospitals. Innovative approaches are needed. ObjectiveWe tested whether an innovative, theory based, team and leaders-directed strategy would be more effective in increasing hand hygiene compliance rates in nurses than a literature based state-of-the-art strategy. Design and settingA cluster randomised controlled trial called HELPING HANDS was conducted in 67 nursing wards of three hospitals in the Netherlands. ParticipantsAll affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). MethodsThe control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-of-the-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months. We monitored nurses’ HH compliance during routine patient care before and directly after strategy delivery, as well as six months later. Secondary outcomes were compliance with each type of hand hygiene opportunity, the presence of jewellery and whether the nurses wore long-sleeved clothes. The effects were evaluated on an intention-to-treat basis by comparing the post-strategy hand hygiene compliance rates with the baseline rates. Multilevel analysis was applied to compensate for the clustered nature of the data using mixed linear modelling techniques. ResultsDuring the study, we observed 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI 1.33–2.02) in favour of the team and leaders-directed strategy. ConclusionsOur results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues. Trial registrationClinicalTrials.gov [NCT00548015].

A Quality Assurance Project to Track Compliance with Autoclave Maintenance and Use of Biological Indicators in Outpatient Physician Offices

percent). In 2004, a targeted assessment of HCWs compliance with HH was conducted in our facility identifying a similar compliance rate to the nation. In order to improve compliance, the HH Program was created comprising of the Hand Hygiene Compliance Team. Project: Our Program was based on the Institute of Healthcare Improvement (IHI) “How to Guide: Improving Hand Hygiene.” The four IHI components to improve compliance were implemented: 1) education of staff was conducted through employee training and multi-component publicity campaigns, 2) improvement of HH technique using several methods, 3) increase availability of alcoholbased hand rubs(ABHRs) throughout the facility, 4) HH observations performed using Center for Disease Control and Prevention (CDC) guidelines. Results: 1) Education of staff was conducted through orientation, annual training and section specific training. Twomulti-component campaigns were implemented-first one in 2006, and the second in 2008. Campaigns included: HH posters, life size figure of facility leader, HH pamphlets, quarterly HH articles, HH trophy, incentives for patients/staff and HH surveys for the second campaign. Survey results (2009-2011) reveal that staff awareness of the campaign increased with each year and was above 90% and patient awareness was above 80%. 2) Correct techniques for using an ABHR and handwashing were discussed during educational sessions, 2 videotape Presentations, and using fluorescent dye-based training methods. 3) Pocket-size ABHRswere distributed and a survey of the facility was conducted to maximize the availability of ABHR wall units in patient care areas. 4) HH compliance checklist was created for use by trained observers. Targeted areas were surveyedmonthly with a minimum of 30 opportunities for HH observed, immediate feedback given, and compliance rates reported to leadership. Results: 24,840 observations were performed from 2006 to 2011, with the most observations done in 2006 (5,369) and the least in 2011 (2,991). The facility goal was set at 90% compliance rate and was reached in the latter part of 2008.The lowest overall compliance rate was 77% in 2006/2007, and the highest compliance rate was 94% in 2011. Physicians/Respiratory Therapy technicians improved the most.

Effects of HH education program on HH compliance among empolyess working in a tertiary care setting in Saudi Arabia

King Abdulaziz Medical City conducted a pilot study monitoring the rates of HH compliance among healthcare workers over time.

Sustained Hand Hygiene Improvement in a Pediatric Teaching Hospital During and After the H1N1 Influenza Pandemic

accurately measure HH compliance improvement. A group of IP Champions was formed that included nursing & ancillary representatives as advocates and this was a key component in our success. They were energized and took it back to their units. Champions made posters to bring awareness of the importance of HH. IP taught them the WIPES Campaign to measure HH performance as both before and afterpatient contact counting as one episode of HH compliance. With a newly-designed patient care pavilion with single patient rooms with large windows made observing compliance easy. The patient’s room is broken down into three sections: the nurse’s work area which includes a wash station, the patient section and the family area. At each nurse server, a sink is available for HH. The IP took individual pictures of hospital staff taking the pledge to commit to the campaign. Pictures were posted throughout the hospital. Computer screen savers were made to promote the campaign and pictures of workers taking the pledge were flashed across the screen. The group purchased a trophy to be given to the nursing unit with the most improved compliance rate for the month. A celebration including treats was given to the unit.

Quality Management Systems/Process Improvement/Adverse Outcomes Use of Latex, All-Silicone, and Silver-Coated All-Silicone Foley Catheters as Options for Indwelling Foley Catheters with the Objective of Lowering Healthcare Acquired Catheter-Associated Urinary Tract Infections: Impact on Quality Objectives

LESSONS LEARNED: The importance of establishing and maintaining compliance with regard to basic ICP cannot be understated. Sustained organizational change has not been fully realized however improvements are occurring gradually over time. The downward trends in HA MRSA have been achieved with an emphasis on fundamental ICP including Standard Universal Precautions, HH and appropriate use of gloves. No resources were vested in active surveillance cultures or Contact Precautions. In conclusion, HH compliance needs ongoing reinforcement. With increased administrative appreciation of and endorsement for the initiatives, sustained organizational behavioral change and further decreases in HAI can occur without the burden of additional healthcare resources.

“Operation Come Clean” – A Novel Approach To Improving Hand Hygiene Compliance at New York-Presbyterian (NYP) Hospital, the University Hospital of Columbia and Cornell

ISSUE: Achievement and maintenance of hand hygiene (hh) compliance rates of 80-100% are a challenge when published studies show compliance rates of 30-50% without an active hh program. Clear and public administrative support with consequences for lack of adherence is essential. NYP expanded upon published strategies and developed Operation Come Clean (OCC) to achieve our goal.

A performance improvement project for reducing nosocomial infections in the neonatal intensive care unit

ISSUE: Hand hygiene is critical in preventing infections among neonatal intensive care unit (NICU) patients. The Centers for Disease Control and Prevention (CDC) has reported adherence of healthcare workers to hand hygiene practice to be poor, with an overall average of 40%. The NICU infection prevention committee of our clinic initiated a hand hygiene awareness program in conjunction with the Vermont Oxford Network's Quality Improvement Collaborative for Reducing Nosocomial Infections in the NICU. PROJECT: The performance improvement cycle "plan, do, study, act" (PDSA) was used to guide the HH awareness program. An observational HH audit tool was created to assess compliance among physicians (MDs), nurses (RNs), and respiratory therapists (RTs) before and after patient care contact. Staff members were informed that unidentified coworkers would conduct random observations. Baseline HH compliance rates were established. Staff members were educated on the importance of HH in reducing nosocomial infections in the NICU. In addition, current bloodstream infection (BSI) rates/1000 central venous catheter (CVC) days were posted and emphasized for assimilation into practice. Observations were conducted, at random, over a 4-month period following the start of the program. RESULTS: Baseline HH audits revealed that prior to patient contact MDs, RNs, and RTs compliance rates were 100%, 34.5%, and 35.7%, respectively. Baseline HH audits revealed that after patient contact MDs, RNs, and RT compliance rates were 50%, 46.6%, and 71.4%, respectively. HH compliance fluctuated during this test period. However, there was a marked overall improvement among all staff members. LESSONS LEARNED: Using this "spy" approach, we were able to find areas of weakness in staff compliance with HH. Staff members were re-educated on the potential for patient-to-patient and environmental transmission of pathogens.