Impact of a Comprehensive Hand Hygiene Program on Compliance with CDC Guidelines at a Children's Hospital

Background:

Hand hygiene has been identified as one of the most important measures to reduce healthcare-associated infections. Although a hand-hygiene monitoring program has been in place at the Children’s Hospital and Medical Center in Omaha, NE since July 2007, compliance with the Centers for Disease Control and Prevention (CDC) guidelines for hand hygiene has been variable.

Objective:

To evaluate the impact of a comprehensive hand hygiene program on compliance with the CDC guidelines.  

Methods:

The program included:

1)Staff education via various methods including Grand Rounds, Lunch and Learns, and a “boot camp” where certified infection preventionists performed actual observation of hand hygiene.  All staff as well as students with direct patient contact were educated.

2)Patients and parents were taught and empowered through a “Kids Clean Hands” program as well as by supplying a pin and card to all hospitalized patients.  The card describes the importance of hand hygiene and encourages caregivers to ask providers questions about hand hygiene.

3)Alcohol-based hand gel was provided in and outside each patient room to facilitate access, in addition to a sink with soap and water in each room.

4)Personalized colorful posters were hung on each patient bed and placed outside each room to remind staff about the need for hand hygiene. 5)Trained unidentified and known observers were recruited to record episodes of hand hygiene compliance.  Data on compliance were collected before and after the program was initiated.

Results:

Prior to the initiation of the program, compliance with hand hygiene varied significantly from month to month (7 – 97%) as recorded by unidentified observers.  After initiation of the program, the variability has decreased (24-72%) with unidentified observers and has been high (91-94%) with known observers.  Importantly, physician compliance has improved from 22% to 64%.  Unfortunately, median student and resident compliance remains low at 30%.  The median compliance rate for nursing staff has been 62% and for all other staff 58%.

Conclusions:

Despite rigorous efforts to improve compliance via a comprehensive program including staff, students, patients and their caregivers, hand hygiene remains a challenge at the Children’s Hospital and Medical Center in Omaha, NE.  This study has helped identify areas for improvement particularly among students and residents.  A peer-to-peer education component has been added recently to try and improve compliance rates further.