997. Interpretive and Adaptive Dynamics associated with implementing a Hand Hygiene Improvement Initiative
Session: Poster Abstract Session: Hand Hygiene 2012
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
  • Szymczak IDSA Poster FINAL.pdf (1.2 MB)
  • Background: The successful implementation of infection prevention practices is often attributed to organizational “culture change,” yet we know little about the actual social processes and dynamics that undergird a change in organizational culture. The objective of this study was to identify social barriers and facilitators to the implementation of the World Health Organization’s (WHO) hand hygiene (HH) guidelines in an academic hospital setting in the United States.

    Methods: This study was an 18 month qualitative case study of one academic pediatric hospital’s experience implementing a HH improvement initiative based on the WHO “My 5 Moments for Hand Hygiene” using data gathered by ethnographic observations of meetings related to the initiative and in-depth, semi-structured interviews with hospital staffWe observed 90 meetings and completed 100 interviews with a purposive sample of 3 strata of hospital staff (senior leaders, midlevel managers, and frontline personnel).

    Results: Barriers to implementation were 1) questioning the credibility of HH audit data; 2) difficulty translating the “5 Moments” to hyper-local setting, workflow and practice; and 3) hesitation to give feedback to colleagues, especially across disciplines, about lapses in HH practice.  Strategies to overcome these barriers were 1) identifying engaged and thick-skinned local champions who accepted the audit data as “real;” 2) providing staff with qualitative content analyses of HH lapses based on audit data from their unit; 3) supporting local, adaptive work to make sense of the “5 Moments” by unit and occupational group; and 4) developing strategies that frontline staff could use to provide person-to-person performance feedback while providing patient care that minimized stigma and resistance.

    Conclusion: We found that the implementation of a HH improvement initiative involved considerable social and adaptive barriers, arising primarily from staff perceptions of the credibility of audit data and the feasibility of transferring the WHO guidelines into their everyday practice.  We identified a number of strategies that were successful in mitigating these barriers and could be adopted by other institutions seeking to implement a HH improvement initiative.

    Julia Szymczak, MA1, Sarah Smathers, MPH, CIC2, Eileen Sherman, MS, CIC2, Kelly Fischbein, MS2 and Susan Coffin, MD, MPH3, (1)Sociology, University of Pennsylvania, Philadelphia, PA, (2)Children's Hospital of Philadelphia, Philadelphia, PA, (3)The Children's Hospital of Philadelphia, Philadelphia, PA


    J. Szymczak, None

    S. Smathers, None

    E. Sherman, None

    K. Fischbein, None

    S. Coffin, None

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