991. A Multidisciplinary Approach to Improving Hand Hygiene Monitoring
Session: Poster Abstract Session: Hand Hygiene 2012
Friday, October 19, 2012
Room: SDCC Poster Hall F-H

Hand hygiene (HH) is the most effective means of reducing healthcare-associated infections, yet it is documented that compliance is frequently suboptimal. Educational interventions are difficult and less effective without (1) the ability to trend HH compliance efficiently (2) capturing workgroup specifics in real-time and (3) a standardized VISN system of reporting. 


A cross-functional improvement team of software experts, clinicians, and systems engineers partnered to create, pilot, and implement a standardized electronic HH Monitoring and reporting tool within 8 facilities within the New England region of the Department of Veterans Affairs.  Using customer feedback from the current processes of submitting paper forms, the first electronic prototype was created and user tested at a single site for 6 months.  The initial design was further refined by applying human factors and systems thinking focused on improving entry accuracy / efficiency and accommodating multiple facilities with varying needs.


The new process will eliminate 88.5 working days per year.  At a single facility, the number of total observations per year increased by 261%, from 2104 to 7582. The number of personnel completing observations has increased by 6 times.  Metrics are available in real time with clear indication of locations lacking entries.  Previous to the process change reports were created on a monthly basis. Unexpected changes in data are now spotted within 10 working days or less, allowing interventions or education more quickly. Site-to-site comparisons are now possible.


A multidisciplinary improvement team has been key to designing a standard, easy to use, and spreadable process.  The standard process is what allows for targeted interventions on improving compliance.  Improved visibility of new metrics is now suggesting there may be variation in compliance reported because of observer bias, which may require additional training.  Pre-change all sites reported a desire to increase the number of observations and observers at their site.  By applying human factors and systems thinking to the hand hygiene observation process, we were able to realize significant increases in user satisfaction and process oversight.

Judith Strymish, MD1,2, Stephanie Triplett, MHA3, Kalpana Gupta, MD, MPH1 and Dennis Drapiza, RN4, (1)VA Boston HCS, West Roxbury, MA, (2)Harvard Medical School, West Roxbury, MA, (3)Veterans Engineering Resource Center, Boston, MA, (4)Infection Control, VA Boston Healthcare System, West Roxbury, MA


J. Strymish, None

S. Triplett, None

K. Gupta, None

D. Drapiza, None

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