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Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Healthcare worker (HCW) hand hygiene (HH) is known to interrupt transmission of pathogens and to be associated with reduction in healthcare-associated infections (HAI) and mortality. However, achieving reliable adherence to HH policies has proven to be a major long term challenge for healthcare epidemiologists.
Objective: To determine whether a 3 year multifaceted improvement program was associated with sustained improvement in HCW HH and reduction of HAI at our rural academic medical center.
Methods: Our strategy included implementation of 5 key elements over a 3 year period: regular measurement and feedback of observed HH compliance; education of staff about HH, and competency certification; improved availability and convenience of HH products; leadership and accountability; marketing and communication. Workgroups were assigned to develop activities related to each of these elements. To assess implementation of our strategies during the 3 year period, we measured the number of HH observations; the number of visits to the website where unit-specific HH compliance and HAI data were reported monthly; the number of staff who were certified “competent” in HH, and the inventory of hand sanitizer purchased by the facility. To assess effectiveness of our strategies, we reviewed monthly HH compliance and HAI “index” (calculated by adding all bloodstream infections, Staphylococcus aureus infections, and Clostridium difficile infections attributable to inpatient or outpatient healthcare, expressed as the total number of infections /1000 inpatient days).
Results: Measurement and feedback began in 2006. From 2006 to 2008, the average number of HH opportunities observed monthly doubled, from 246 to 498. Over the same time period, average monthly visits to the “report cards” website increased 4.6 fold from 30 to 138. During 2008, the HH competency certification was implemented: 1845 staff (25% of all staff; 46% of direct HCW) demonstrated competency in HH and received a sticker for their ID badge. Between 2006 and 2008, the number of refills purchased for wall-mounted hand sanitizer stations increased 37% from 32,960 to 45,184, and the number of desktop hand sanitizers purchased increased 86% from 55,500 to 103,392. During the 3 year period, HH compliance improved from 46% to 86% and the HAI index fell 35% from 4.9 to 3.2 infections/1000 inpatient days.
Conclusions: A multifaceted strategy implemented over a 3 year period has been associated with substantial and sustained improvement in HH performance and significant reduction in HAI incidence. Process measures reflect successful implementation of planned interventions and provide evidence to support an association between interventions and the outcomes achieved. Our study provides 21st century evidence for the feasibility of HH improvement programs and for the strong link between HH improvement and HAI reduction.
Objective: To determine whether a 3 year multifaceted improvement program was associated with sustained improvement in HCW HH and reduction of HAI at our rural academic medical center.
Methods: Our strategy included implementation of 5 key elements over a 3 year period: regular measurement and feedback of observed HH compliance; education of staff about HH, and competency certification; improved availability and convenience of HH products; leadership and accountability; marketing and communication. Workgroups were assigned to develop activities related to each of these elements. To assess implementation of our strategies during the 3 year period, we measured the number of HH observations; the number of visits to the website where unit-specific HH compliance and HAI data were reported monthly; the number of staff who were certified “competent” in HH, and the inventory of hand sanitizer purchased by the facility. To assess effectiveness of our strategies, we reviewed monthly HH compliance and HAI “index” (calculated by adding all bloodstream infections, Staphylococcus aureus infections, and Clostridium difficile infections attributable to inpatient or outpatient healthcare, expressed as the total number of infections /1000 inpatient days).
Results: Measurement and feedback began in 2006. From 2006 to 2008, the average number of HH opportunities observed monthly doubled, from 246 to 498. Over the same time period, average monthly visits to the “report cards” website increased 4.6 fold from 30 to 138. During 2008, the HH competency certification was implemented: 1845 staff (25% of all staff; 46% of direct HCW) demonstrated competency in HH and received a sticker for their ID badge. Between 2006 and 2008, the number of refills purchased for wall-mounted hand sanitizer stations increased 37% from 32,960 to 45,184, and the number of desktop hand sanitizers purchased increased 86% from 55,500 to 103,392. During the 3 year period, HH compliance improved from 46% to 86% and the HAI index fell 35% from 4.9 to 3.2 infections/1000 inpatient days.
Conclusions: A multifaceted strategy implemented over a 3 year period has been associated with substantial and sustained improvement in HH performance and significant reduction in HAI incidence. Process measures reflect successful implementation of planned interventions and provide evidence to support an association between interventions and the outcomes achieved. Our study provides 21st century evidence for the feasibility of HH improvement programs and for the strong link between HH improvement and HAI reduction.