Inpatient Unit-Based Safety Culture Factors Associated with Sustained Hand Hygiene Compliance
Background: Following institution of a hand hygiene (HH) program at an academic medical center, inpatient unit HH compliance increased from 58 to 92% over 3 years. The rate of improvement varied, with some units having early, sustained increases, and others exhibiting protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit safety culture measures.
Methods: Adult inpatient units (N = 35) were categorized based on their pattern of HH compliance improvement (e.g. laggards = did not attain 90% compliance at three years; early adopters = achieved 80% compliance by year 1 and sustained high compliance during years 2-3; other = non-laggard/non-early adopter). Unit-based safety culture measures were collected, including nursing satisfaction scores (National Database of Nursing Quality Indicators [NDNQI]), patient ratings of quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems [HCAHPS]), and patient complaint rates. Case Mix Index (CMI), staff turnover rates, and annual changes in patient volume were also collected. Associations between each metric and laggard status were tested using a Mann-Whitney U test. Multivariate ordinal regression analysis was conducted using the outcomes of early adopter, laggard, or other and the variables of nursing satisfaction, CMI, patient complaint rate, and staff turnover rate.
Results: Laggard units had lower nursing satisfaction scores, lower patient ratings of quality, and a higher rate of patient complaints, although these differences were not statistically significant, potentially due to low sample size. Staff turnover rates, CMI, patient ratings of teamwork, and patient volume changes did not significantly differ between the groups. In the multivariate model, nursing satisfaction scores, CMI, and the patient complaint rate were, as a group, significantly associated with laggard status, (R-Squared = .35).
Conclusion: Uptake of HH compliance was associated with factors related to a unit's safety culture and teamwork. Staff turnover rates and patient volume changes were not associated with degree of uptake, suggesting that a strong unit culture may minimize the impact of such transitions on quality improvement programs.
G. Hickson, None
D. Wang, None
M. Dubree, None
N. Feistritzer, None
N. Wells, None
T. Talbot, None