245 Use of a Multidimensional Intervention Results in Improved Hand Hygiene Compliance among Pediatric Healthcare Workers

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
W. Matthew Linam, MD, MS , Arkansas Children's Hospital, Little Rock, AR
Beverly Connelly, MD , Cincinnati Children's Hospital, Cincinnati, OH
Background: Hand hygiene compliance among healthcare workers (HCWs) remains low. Barriers related to HCW knowledge, hand hygiene supply availability, and longstanding habits have made sustained improvement difficult. The use of multidimensional interventions is thought to be more effective than single interventions.
Objective: To develop and test a multidimensional intervention to improve hand hygiene compliance among healthcare workers from a baseline of 74% to greater than 90%.

Methods: This was a quasi-experimental study using a staggered intervention design.  The setting was a 475-bed tertiary children’s hospital. Hand hygiene compliance was defined as acceptable hand hygiene both before and after contact with the patient or the patient’s care environment. Measurement of HCW hand hygiene compliance was performed by covert observations made during routine patient care. Interventions that addressed leadership support, HCW knowledge, hand hygiene supply availability, and unit culture were tested on 2 units using the model for improvement.

Results: Units A and B represented similar general pediatric units. The 12 months of pre-intervention data showed the percentage of hand hygiene compliance both before and after patient care was significantly lower (P < 0.001) on unit A compared to unit B (65% vs. 74%). Interventions began on unit A on November 10, 2008 and on unit B on March 23, 2009. After the interventions, hand hygiene compliance increased on unit A (65% to 91%) and on unit B (74% to 92%). Identifying HCWs who failed to perform hand hygiene and offering alcohol hand rub to them prior to patient contact resulted in the greatest improvement in compliance. Improvements have been sustained on both units for 7 months. Conclusions: Use of a multidimensional intervention resulted in sustained improvement in hand hygiene compliance on two pediatric units with different baseline hand hygiene compliance.