503. Importance of Incorporating an Ongoing Program of Periodic Validation in Hand Hygiene Adherence Program
Session: Poster Abstract Session: Infection Control and Skin Hygiene
Friday, October 21, 2011
Room: Poster Hall B1
Background: Healthcare organizations are charged with achieving >90% compliance with proper hand hygiene (HH) among Health Care Workers (HCW) as an essential component of decreasing the spread of hospital acquired infections. Verification of HCW HH compliance is often executed through observations.   

Methods: Since January 2007, hand hygiene (HH) observations are recorded on a custom web form, warehoused, and reported in real time on a HH dashboard available to physician and nursing leadership.  Observations are standardized and performed by either a full time Quality and Patient Safety (QPSI) employee or by a nursing unit based healthcare worker (Peer).  The observations are conducted among 18 clinical institutes and 91 treatment areas. All observations are done using identical criteria for compliance.  A comparison of QPSI to peer reporting was performed for 2009-2010.

QPSI personnel are supposed to be unknown to HCWs, but other studies have shown that HCWs may become aware of their identity.  Therefore, in July 2010, Infection Control Practitioners (ICP) performed additional “secret” observations using the same methodology in attempts to validate reported compliance.  The χ2 test was used to determine whether differences between routine peer observations to QPSI’s observations, and peer + QPSI’s observations to ICP’s observations were statistically significant. 

Results: From 2009-2010, there were 34,219 QPSI observations with a reported compliance rate of 87.6% and 32,598 peer observations with a reported compliance rate of 95.7% (p<0.0001).  During the one month “secret” audit in July 2010, there were 3051 peer + QPSI’s observations with a reported compliance rate of 94.4% and 638 “secret” ICP observations with a reported compliance rate of 72.1% (p<0.0001).

Conclusion: Peer reporting of HCW HH compliance are significantly higher than QPSI auditor observations in our institution.  Compliance rates from peer + QPSI observations are significantly higher than “secret” ICP audits.  This is consistent with previous literature showing that employee recognition of QPSI auditor can increase HH compliance rates via observer bias.  Hospitals may require multiple different measures, such as “secret” audits to get a true assessment of HCW HH practices.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Kimberlee Fong, DO, Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, Eric Hixson, PhD, MBA, Business Intelligence, Cleveland Clinic Foundation, Lyndhurst, OH, Cynthia Fatica, RN, BSN, CIC, Cleveland Clinic, Cleveland, OH, Steven Gordon, MD, FIDSA, Infectious Disease, Cleveland Clinic, Cleveland, OH and Thomas G. Fraser, MD, Cleveland Clinic Foundation, Cleveland, OH


K. Fong, None

E. Hixson, None

C. Fatica, None

S. Gordon, None

T. G. Fraser, None

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