Improved Hand Hygiene Compliance through the use of a Disciplinary Program for Non-Compliant Physicians

Background: The most important, fundamental method of reducing the risk of Hospital Associated Infections is the practice of effective hand hygiene (HH). In an effort to produce sustained improvement in hand hygiene compliance (HHC) among physicians, a program of escalating disciplinary actions was developed and implemented for physicians found to be non-compliant with HH.

Objective: Improve overall HHC to 90%; improve physician HHC by 50% over baseline with an ultimate goal of sustained physician HHC of 90%; eliminate “Never” HH violations among all healthcare workers, but especially among physicians where they are most prominent.

Methods: An escalating disciplinary program for physician non-compliance with HH up to and including suspension of clinical privileges was developed and instituted. Physician compliance relative to the desired behavior of performing effective HH before entering and exiting a patient’s room or bed space was assessed in one of three ways: 1.) “Before AND After, 2.) “Before OR After” or 3.) “Never”.

Results: Overall HHC among all healthcare workers improved from a baseline rate of 72.6% during the 11 months leading up to the initiation of the disciplinary program to 82.6% in the 5 months after initiation of the program. Physician HHC improved pre- to post-intervention from 53.8% to 74.4%, an improvement of 38.2% over baseline. “Before and After” observations increased substantially. “Never” violations among physicians were reduced from an average of 22 (range, 7-80) violations per month before the disciplinary program to an average of 3.6 (range, 0-7) violations per month in the 5 months following initiation of the program. Comparing pre- and post-intervention HHC for non-physician healthcare workers, nurse compliance with HH dropped slightly (89.7% to 86.6%) while ancillary healthcare workers improved their compliance (77.8% to 88.8%) with HH.

Conclusions: Although the desired objectives of 90% overall improvement in HHC and 50% improvement in physician HHC over baseline were not achieved in the first 5 months of this initiative, significant and sustained improvement in HH among physicians was achieved using an escalating system of disciplinary actions for non-compliers. Substantial improvement in performance of effective HH and a significant reduction in “Never” violations of HH policy was seen without suspending the clinical privileges of a single physician. Ancillary healthcare workers’ compliance with HH improved along with that of physicians, suggesting a “role-modeling” effect. It is anticipated that further improvement in HHC among physicians at our institution will be made possible by sharing data demonstrating the positive impact of this initiative with physician stake-holders and by publicizing the list of physicians violating HH policy in order to evoke peer pressure.