Targeted Solutions to Increase Hand Hygiene
Background : Hand hygiene (HH) is a fundamental behavior for infection prevention. However, HH is commonly suboptimal, with compliance often only ~30-60%. In 2010, the Joint Commission Center for Transforming Healthcare launched the Targeted Solutions Tool (TST) for Hand Hygiene to aid institutions to increase HH compliance. Building on the principles and tools provided by the TST, we launched a HH Quality Improvement (HHQI) initiative on three pilot units.
Methods : Two medical wards and an ICU were in the HHQI pilot. A cadre of anonymous observers were trained and deployed for a two month period of covert baseline observations (n>1000) spanning all shifts/all days. Proper HH was defined as washing upon entry and exit from the patient environment. The second phase of the HHQI involved Just In Time Coaches (JITC) tasked to interact with staff on the pilot units, to coach noncompliant behavior, and to solicit the barriers to best practices. A team of JITCs seen as leaders in the organization, including nurse managers and medical directors, were trained and deployed on the pilot units.
Results : Figures 1-3 show pre and post-JITC HH compliance overall by unit, upon entry and exit, and by healthcare worker type.
Conclusion : Baseline HH rates at our institution were suboptimal. Interventions with JITCs proved to be an effective tool to improve compliance and better understand barriers to best practices. JITCs found that HH noncompliance was largely due to many staff believing that HH was not required if they were entering a room not planning to have direct patient contact. Others believed gloves were an acceptable replacement for HH. While the goal is still 90% compliance, JITC was associated with statistically significant increases in HH rates early on during the pilot. It remains to be seen if this can be further improved and sustained, but the robust response to coaching indicates that firm emphasis on HH from leadership on the units can lead to rapid and significant improvements in compliance. Further efforts of the HHQI will include expanded institution wide JITC and education programs, as well as increasing the number of alcohol dispensers to facilitate proper HH. By facilitating appropriate behaviors while changing the culture of safety we hope to see greater sustained improvements in HH compliance.
J. Bailey, None
M. Wawrzyniak, None
W. Barron, None
M. Martin, None
K. Fujiu, None