A Novel Motivational Method for Improving Hand Hygiene Compliance Among Healthcare Providers

Background: Compliance to hand hygiene (HH) standards among healthcare providers (HCP) remains unacceptably low at most centers. Interventions to motivate HCP have demonstrated limited impact, which is typically unsustainable.

Objective: To determine the effect of a novel approach to motivating HCP to improve and sustain HH compliance.

Methods: The study was conducted on two units of an urban academic medical center.  Nurses working on these units participated in a novel Giving for Performance (G4P) program, designed to motivate HCP to improve HH compliance.  For the study, a philanthropic donation was made to benefit patients on the units in a manner chosen by participating nurses. During G4P, the amount of charitable reward was linked to weekly HH rates compared with the increase from baseline. In the case of 100% compliance during the entire G4P period, the unit would earn $10,000.  HH compliance was monitored through direct observation at baseline and over consecutive 8-week periods in the two units.  During each period, the unit was assigned to either G4P or a standard CDC-modeled HH promotional campaign, with the unit assignments crossing over at the end of the first period.   

Results: Due to an unanticipated degree of staff mixing between the two units, the decision was made to compare HH compliance in each unit between three distinct periods: baseline (pre-intervention), G4P, and standard promotion campaign. During the entire study period, a total of 2,326 HH observations were recorded.  A significant increase from 55% compliance at baseline to an average 71.3% during G4P occurred in Unit 1 (p<.0001). Following G4P, Unit 1 received the standard campaign and averaged 77.8% compliance, suggesting the sustainability of G4P's impact (p=.0522).  In Unit 2, significant increase was seen from baseline rate of 58% to an average 72.3% during the standard campaign (p<.0001).  G4P was then implemented on Unit 2, during which an average 83.9% HH compliance rate was noted, a significant increase from performance during the standard campaign (p=.0003).

Conclusions: The results of this study demonstrate the effectiveness of a novel approach linking charitable donation to motivation of HCP.  The G4P initiative was successful in not only increasing HH rates from pre-intervention baseline, but adding further value after deployment of a standard, effective promotion program.  In that many healthcare facilities already focus on cultivating philanthropic contributions, the opportunity to link donation to performance improvement offers great opportunity on a larger scale. Further research of G4P is needed to determine the true impact of this motivational method on individual HCP behavior.