Significantly Improved Hand Hygiene

Background:  Boston Medical Center (BMC) is a 626 bed not-for-profit teaching hospital with approximately 30,000 total discharges and 750,000 patient visits per year. Hand hygiene (HH) is a key component of a comprehensive Infection Control and Patient Safety Program. Implementation of a HH program can be challenging and compliance is difficult to measure. Improvements are unlikely to be sustained until all members of the healthcare team embrace a culture of safety that includes HH.

Objective: To fulfill the expectation that health care workers (HCW) perform HH before and after each patient care event and reach or exceed the performance targets that were tracked by measuring HH product volume.

Methods: HCW were provided with positive feedback about their HH performance, using product volume as the core data. The data were organized by patient care unit. Performance was calculated using the number of patients cared for and the volume of HH product [soap and alcohol rub] used per day. Performance goals were based on previous best practice defined as 144 HH events/patient/day in the ICU setting and 72 HH events/patient/day in the non-ICU setting. The data were fed back as monthly scores, by patient care unit, and as hospital-wide aggregates. Scores were benchmarked against expected performance targets. Providing feedback was a hospital priority. Scores were published on the hospital website, discussed by the CEO at monthly leadership meetings, and distributed and discussed throughout the organization. Achieving hand hygiene targets was included in clinical leadership performance expectations. While volume measurement cannot provide specific information about HH, it did offer consistent measure of progress at regular time intervals for discrete patient care units. This feedback was used to demonstrate improvement and encourage compliance across all clinical services and departments.      

 

Results: From September 2006 to September 2009, there was a statistically significant increase in HH performance, as measured by product volume, from 42% of the best practice goal to over 100% throughout the institution (Z score for comparison of proportions 13.2, p < 0.00001 for ICU; Z score 9.5, p < 0.00001 for Non-ICU). 

 

Conclusions: The high visibility of the aggregated, corporate scorecard assured that the entire community, from patients to the Board of Trustees, was involved in improving HH.  Area/service scorecards stimulated evaluation of practices and barriers to performance as well as a variety of area and service based performance improvement projects aimed at improving compliance.  The next challenge will be to sustain these gains.