Effects of an Infection Prevention Promotion Program Based on PRECEDE Model on Hand Hygiene Behaviors among Healthcare Providers: Two Year Results of the WIPES Infection Prevention Promotion
Background: Healthcare- associated infections (HAIs) are a leading cause of death in the United States. Hand hygiene (HH) remains a cornerstone intervention for preventing HAIs and transmission of multidrug resistant organisms in the healthcare setting. Unfortunately, adherence among healthcare workers (HCWs) to recommended hand hygiene practices is poor.
Objective: To improve HH compliance in a large urban teaching hospital in Baltimore, MD.
Methods: In October 2006, HH compliance was measured after using ‘undercover' observers who directly observed HCW practices. HCWs were educated to clean their hands using either alcohol based hand rubs or soap and water before and after patient care, before and after gloves use, before aseptic procedures and after exposure to bodily fluids. To minimize Hawthorne effect and due to patient privacy reasons, observers were instructed not to follow providers into patient rooms and data was collected on HH behaviors upon entry and exit to patient environment (including before and after glove use and between patients). Compliance was measured as whether HH was performed per opportunity. In October 2007, systematic HH measurement began. In November 2007, we developed a program to improve HH. This included a multimedia communications campaign, leadership engagement, environment modification, standardized measurement and a web based feedback application. Additional Alcohol hand gel dispensers were placed in November 2007. Alcohol hand gel consumption was measured also.
Results: The number of HH observations has increased from 481 to 3,387 monthly. Hand hygiene compliance increased three fold, from 21% in 10/07 to 63% in 10/09 (p<0.001). Increases were noted across all hospital departments. A 50% increase in consumption of alcohol based hand gel from a 1,050 liters containers to 2,000 liters per month occurred. The hand hygiene compliance increased among all healthcare workers (p<0.01). Specifically among it nursing providers increased from 24% in Oct 2007 to 68% in May 2009 (p< 0.001), among medical providers from 24% to 71% (p< 0.001), and among environmental services personnel from 9% to 45% (p< 0.01). HH compliance is higher when HCWs exit the room than on room entry.
Conclusions: Systematic measurement with data feedback, visual cues and other components of the infection prevention promotion program significantly increased HH compliance. Multidisciplinary programs with feedback of data and leadership attention are needed to promote hand hygiene.