1010. A Rapid Cycle Quality Improvement Project to Improve Compliance with Infection Control Precautions on a Pediatric Ward
Session: Poster Abstract Session: Hand Hygiene 2012
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Background: Adherence to infection control precautions is vital in preventing the spread of infection and has significant implications for nosocomial infection rates and healthcare worker (HCW) safety.

Objective: To measure rates of compliance with infection control precautions on a pediatric ward, and to determine whether a focused educational program with feedback would improve these rates.

Methods: Monitors directly observed clinical and ancillary staff on entering and exiting patient rooms from 12/14/11 – 2/8/12 (pre-intervention) and from 3/19/12 – 3/23/12 (post-intervention). Patient room, type of infection control precaution, whether infection control precautions were carried out in the correct sequence, type of HCW (i.e., nurse, resident, attending, housekeeper), training level of MD if known, and gender were recorded. Intervention consisted of a one week period of focused, intensive, interdisciplinary educational sessions with feedback using rapid cycle quality improvement strategies. A Chi-Square Test for Independence was used to test hypotheses and compare pre- and post-intervention data. 

Results: 159 events were observed during the pre-intervention phase (68 entering, 91 exiting), involving 54% MD, 26% RN, and 20% ancillary staff. Overall compliance with all precautions was 35% (47% among MDs, 32% among RN). Forty-seven percent sanitized their hands upon entering or exiting patient rooms; with a higher percentage on exiting (54%) compared with entering (34%; p=0.0036).

A total of 54 events (27 entering, 27 exiting) involving only clinicians (69% MD, 31% RN) were observed during the immediate post-intervention period. Overall compliance with all precautions was 51% for MD and 29% for RN.  Overall compliance with hand hygiene was 50% (59% exiting, 41% entering; p=0.17). 

Conclusion: There is an opportunity to improve HCW compliance with infection control precautions on the study unit. There was no significant difference in overall compliance before and after a brief but intensive focused intervention (p=0.77). There was also no improvement in overall hand hygiene rates (p=0.4). These results suggest that improvement will require a concerted and sustained effort that goes beyond education and feedback.

Pui-Ying Iroh Tam, MD1, Amy Bettano, MPH2, Zoon Wangu, MD1, Dale Ford, RN, MPH3 and Carol Sulis, MD3, (1)Pediatric Infectious Diseases, Boston Medical Center, Boston, MA, (2)Epidemiology, Boston University School of Public Health, Boston, MA, (3)Boston Medical Center, Boston, MA


P. Y. Iroh Tam, None

A. Bettano, None

Z. Wangu, None

D. Ford, None

C. Sulis, None

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