Program Schedule

Individual Accountability and Direct Feedback to Achieve and Sustain Good Hand Hygiene Performance

Session: Poster Abstract Session: Hand Hygiene
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • HH poster for SHEA 2014 .pdf (579.3 kB)
  • Background: Hand hygiene (HH) is a fundamental infection prevention practice to prevent healthcare-associated infections and transmission of organisms, and is therefore a top patient safety priority. When our hospital initiated rigorous hand hygiene monitoring and data feedback in 2007, HH compliance was extremely low (20-30%).  We planned and implemented a multi-faceted HH improvement program.

    Methods: The Department of Hospital Epidemiology and Infection Control partnered with Executive Leadership, multi-disciplinary HH champions, hospital units and services, and a Hand Hygiene Task Force to implement a comprehensive hand hygiene program including Secret Shopper monitoring by trained observers, timely HH data feedback to units and services, unit- based monitoring and improvement efforts, and a HH Improvement Toolkit.  When HH performance plateaued and further intervention was required, a Direct Feedback program was launched to provide reminders and education at the moment staff was observed missing a hand hygiene opportunity.  Most recently, a HH accountability model was introduced holding staff accountable for individual HH compliance in a disciplinary model with escalating consequences for repeat offences. 

    Results: Hand hygiene compliance increased markedly after the introduction of direct feedback and the accountability model, reaching a record high of 97%.  Performance has been sustained for 6 months, November 2013 through April 2014. High HH performance is seen across all services and provider types. There are 48 units on our Hand Hygiene Honor Roll for sustaining hand hygiene compliance of 90% or greater for 3 or more consecutive months.  MRSA , VRE, and C. difficile transmission decreased and was temporally correlated with the HH compliance increase.

    Conclusion: Hand hygiene improvement requires sustained effort and multi-faceted interventions over a number of years.  Individual accountability and direct feedback were important additions to data monitoring and feedback to achieve culture change and sustained high HH performance.  HH improvement is correlated with demonstrable decreases in MDRO transmission.

    Lisa L. Maragakis, MD, MPH, The Johns Hopkins University School of Medicine, Baltimore, MD, Polly Trexler, MS, CIC, Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, MD, Redonda Miller, MD, Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, Hanan Aboumatar, MD, General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD and Bria Graham, MPH, Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, MD


    L. L. Maragakis, None

    P. Trexler, None

    R. Miller, None

    H. Aboumatar, None

    B. Graham, None

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