High Five for a Healthy New Hampshire: Impact of a Statewide Hand Hygiene Campaign

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.  Beginning in 2008, we planned and coordinated a statewide HH improvement campaign with a goal of 100% HH compliance in New Hampshire's 26 hospitals.  In 2010, the state issued its first public report on HAI. 

Objective: To evaluate the impact of a multifaceted HH improvement program in hospitals across the state.

Methods: The High Five for a Healthy New Hampshire campaign was built on 5 key elements:1)  regular measurement and feedback of observed HH compliance; 2) education of staff about HH, and competency certification; 3) improved availability and convenience of HH products; 4) leadership and accountability; 5) marketing and communication.  We created a website (http://www.healthynh.com/fhc/initiatives/high5/index.php) where implementation tools related to each element were shared.  Hospitals submitted HH compliance data, collected by trained observers, using a standard tool, at baseline and at 6 month intervals.  Data were coded in order not to disclose hospital’s identities.  In August 2010, the state released its first public report of rates of selected healthcare-associated infections, using NHSN methodology.  We reviewed patterns of change in HH compliance at each hospital over time, and correlated HH performance with reported HAI rates.

Results: All 26 hospitals participated in the campaign.  Of the 23 hospitals that reported data at each of the 4 timepoints, 17 (74%) showed significant improvement over time, ranging from a 3% to a 37% increase in HH compliance.  At 2 hospitals (9%) HH compliance fell significantly and at 4 hospitals it did not change.  At baseline, 7 (27%) of 26 hospitals reported HH compliance of 90% or higher; in 2010, 17 (74%) of 23 hospitals reported compliance of 90% or higher.  Overall HH compliance at the state’s hospitals improved from 82% (13,539/16,541) at baseline to 87% (30,441/34868) in 2009 to 90% (19130/21,145) during the first 6 months of 2010.  In 2009, NH hospitals reported 134 HAI for a rate that was 26% lower than expected based on NHSN data.  Four hospitals had HAI rates that were significantly lower than other hospitals in the state; all 4 had baseline HH compliance of 85% or higher, and 3 of the 4 reported significant improvement to 90% or higher during the campaign. 

Conclusions: A multifaceted statewide strategy has resulted in significant and sustained improvement in HCW HH performance across the state, and in most of the individual hospitals.  Further study is needed to understand the different patterns of improvement in individual hospitals and to explore the potential association of high and improving hand hygiene compliance and lower than expected statewide HAI rates.