Sustainability, Cost and Impact of a Hand Hygiene Observation Program at a Tertiary Care Medical Center

Background: Hand Hygiene (HH) remains a critical infection prevention intervention. Assessing the sustainability of compliance with hand hygiene remains a challenge.

Objective: To describe the sustained results, over a two year period, of a HH observation program at an 820-bed, urban tertiary care center in central Virginia.

Methods: The program consists of a team of roving observers, typically college/graduate students, who are paid an hourly wage. Daily assignments are made for a randomly chosen hospital unit, or a unit specifically designated owing to a recent increase in infections or poor prior HH compliance. Each observer was trained by the same nurse epidemiologist to minimize inter-observer variability. We reviewed data from two 1-year periods (P1:October 2007-September 2008 and P2:October 2008-September 2009) gathered in our HH observation program, including information on overall compliance rates for healthcare providers broken down by specialty site and job classification. We reviewed data on overall program costs for each time period.

Results:

During the 2 year period a total of 69,780 individual hand hygiene observations were made. The overall HH compliance rate was 87.2% with a compliance of 84.0% P1 vs. 90.0% P2. For units observed during both periods, the NICU had the highest overall compliance (94.4%) and the Emergency Department had the lowest overall compliance (57.1%). Overall HH compliance by nurses (89.3%) exceeded that of physicians (72.7%).

Healthcare worker	P1 Total observations	% compliance P1	P2 Total observations	% compliance P2
Nurse	25,234	87.5%	29,160	92.1%
Physician	4,511	66.3%	4,298	79.0%
Radiology technician	314	67.8%	377	79.0%
Respiratory therapy	829	87.5%	1,001	93.3%
Physical Therapy	245	86.5%	619	91.8%
Other	1,267	81.7%	1,925	83.9%
Total	32,400	84.0%	37,380	90.0%

In P1, the program employed 12 staff observers (typically 3 at any given time) who worked a total 2,074 hours for a combined cost of $21,252 dollars. This amounts to $0.66 per observation made. In P2 the program employed 5 staff observers who worked a total of 2550 hours for a combined cost of $25,291. Over 2 years, this amounts to $0.67 per observation.

Conclusions:

1)      Assessing  HH  remains an important element of any infection control program
2)      Our hand HH observation program is both cost-effective and sustainable and has generated important data resulting in HH improvement.
3)      The ongoing use of dedicated graduate and college student compliance monitors has allowed us to accrue large numbers of observations while continuing to keep costs low