Sustaining Hand Hygiene (HH) Near Perfect Compliance (C) with Just Culture (JC) – Accountability for Patient Care
Background: HH is considered the most important way to prevent infections. Previous studies found deplorable Health Care Personnel (HCPs) HHC rates. Zero tolerance for HH nonC was adopted in 2003. Since then an ongoing HH campaign has been in place. HHC increased from 50% to 60% but peaked at 70%. In 2012 University of Pittsburgh Medical Center - Presbyterian (UPMC) HH campaign added JC, a system design to affect behavior. HCP are held accountable for conscious disregard for safety but not for system failures. HH nonC follows normal disciplinary process; verbal warning, written warning, final written warning, termination. JC was implemented in 6/2012 and was associated with an immediate increased to near perfect HHC. Many investigators have reported success after HH initiatives but gains are often not sustainable. The objective of this study was to determine if neatly perfect HHC was sustainable after JC implementation.
Methods: ~800 standardized HH observations were collected monthly by 4 trained covert monitors (CoM). Rates were compared for 2 periods, pre intervention (P1) = 3/2008 – 5/2012 and post intervention (P2) = 6/2012 – 4/2014. Biannual CoM training, education, and use of both soap and alcohol sanitizers were used in both periods. JC was implemented in 6/2012. Education was provided initially and 7/13. Monthly HH observations were validated quarterly by external observers.
HH C increased from a mean of 62.7 % (40,972/65,385) in P1 to 96.9% (18,321/18915) in P2, OR =0.05 (CI, 0.05-0.06, p<10-10) and has been ≥97% over the past 8 months. Overall 117 HCP received progressive disciplinary action; 112 verbal warnings, 1 written warning, 2 terminated, and 2 cases dismissed after JC deemed events to be secondary to system failure .
- Incorporating a JC of patient safety with accountability and potential disciplinary action can drive HHC to near 100% and sustain near perfect HHC.
- Initiatives without accountability may increase HHC but gains are not sustainable.
- The acknowledgment of HH importance can become incorporated into the way work is done and system change can be achieved and sustained when JC system design is utilized.