"Clean in, Clean out" initiative: Improving hand hygiene compliance among frontline healthcare personnel by observations of each other and immediate feedback
Background: Hand hygiene (HH) has an important role in infection control and patient safety in healthcare facilities. The University of North Carolina (UNC) Hospitals has improved our HH compliance, but reached a plateau between 80-90% in recent years. To achieve further compliance we implemented our "Clean In, Clean Out" (CICO) initiative encouraging all healthcare personnel (HCP) to perform observations and provide immediate feedback of each other. Here we provisionally assessed the trends of HCP involvement in this program and HH compliance.
Methods: CICO has been conducted at UNC Hospitals, an 800-bed tertiary care facility since October 2013. Observations were performed of any HCP who entered or exited the patient's room. Providing immediate feedback to non-compliant HCP was encouraged. HCP reported their observations with dates, locations, and job classifications of observers using the mobile iScrub App or paper forms entered in a web-based survey tool. Unit and job classification based reports were provided at least monthly and each location maintained a visual display with real-time data available as charted by observers in their area. Areas with low compliance were required to develop specific action plans. CICO data between October 2013 and March 2014 were evaluated. Our compliance goal was ≥90%.
Results: A total of 46,064 observations were reported during six months. Overall, the number of unique observers increased from 758 in October to 1,026 in March. Increasing trends were observed in the overall compliance and average compliance among the units and job classes who had <90% compliance at the start of the program (Figure 1). The proportion of units which achieved 90% compliance doubled (95% CI 1.0-4.1, p=0.04) from 20.5% (8/39) in October to 41% (16/39) in March. By job classes, housekeeping staff improved their compliance significantly by 21.5% (95% CI 13.9-29.1%, p<0.0001) from 67.9% in October to 89.4% to March.
Conclusion: By involving more and different types of healthcare personnel in hand hygiene monitoring and feedback, CICO helped improve HH compliance among units and departments at low compliance levels. At the end of our 8 month implementation period, we will assess the impact of this intervention on the incidence of healthcare-associated infections.
L. Dibiase, None
T. Schade Willis, None
E. Walters, None
D. Williams, None
J. Bringhurst, None
L. Teal, None
R. Brooks, None
S. Goldbach, None
D. J. Weber, None
W. Rutala, None