BACKGROUND: Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. OBJECTIVE: To improve healthcare workers' HH, and reduce healthcare-associated infections. DESIGN: 3-year interrupted time series with multiple sequential interventions and 1-year post-intervention follow-up. SETTING: Teaching hospital in rural New Hampshire. INTERVENTIONS: In five categories: (1) leadership/accountability; (2) measurement/feedback; (3) hand sanitiser availability; (4) education/training; and (5) marketing/communication. MEASUREMENT: Monthly changes in observed HH compliance (%) and rates of healthcare-associated infection (including Staphylococcus aureus infections, Clostridium difficile infections and bloodstream infections) per 1000 inpatient days. The subset of S aureus infections attributable to the operating room served as a tracer condition. We used statistical process control charts to identify significant changes. RESULTS: HH compliance increased significantly from 41% to 87% (p<0.01) during the initiative, and improved further to 91% (p<0.01) the following year. Nurses achieved higher HH compliance (93%) than physicians (78%). There was a significant, sustained decline in the healthcare-associated infection rate from 4.8 to 3.3 (p<0.01) per 1000 inpatient days. The rate of S aureus infections attributable to the operating room rose, while the rate of other S aureus infections fell. CONCLUSIONS: Our initiative was associated with a large and significant hospital-wide improvement in HH which was sustained through the following year and a significant, sustained reduction in the incidence of healthcare-associated infection. The observed increased incidence of the tracer condition supports the assertion that HH improvement contributed to infection reduction. Persistent variation in HH performance among different groups requires further study.
BACKGROUND: Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. OBJECTIVE: To improve healthcare workers' HH, and reduce healthcare-associated infections. DESIGN: 3-year interrupted time series with multiple sequential interventions and 1-year post-intervention follow-up. SETTING: Teaching hospital in rural New Hampshire. INTERVENTIONS: In five categories: (1) leadership/accountability; (2) measurement/feedback; (3) hand sanitiser availability; (4) education/training; and (5) marketing/communication. MEASUREMENT: Monthly changes in observed HH compliance (%) and rates of healthcare-associated infection (including Staphylococcus aureus infections, Clostridium difficile infections and bloodstream infections) per 1000 inpatient days. The subset of S aureus infections attributable to the operating room served as a tracer condition. We used statistical process control charts to identify significant changes. RESULTS: HH compliance increased significantly from 41% to 87% (p<0.01) during the initiative, and improved further to 91% (p<0.01) the following year. Nurses achieved higher HH compliance (93%) than physicians (78%). There was a significant, sustained decline in the healthcare-associated infection rate from 4.8 to 3.3 (p<0.01) per 1000 inpatient days. The rate of S aureus infections attributable to the operating room rose, while the rate of other S aureus infections fell. CONCLUSIONS: Our initiative was associated with a large and significant hospital-wide improvement in HH which was sustained through the following year and a significant, sustained reduction in the incidence of healthcare-associated infection. The observed increased incidence of the tracer condition supports the assertion that HH improvement contributed to infection reduction. Persistent variation in HH performance among different groups requires further study.
Authors: Irene K Louh; William G Greendyke; Emilia A Hermann; Karina W Davidson; Louise Falzon; David K Vawdrey; Jonathan A Shaffer; David P Calfee; E Yoko Furuya; Henry H Ting Journal: Infect Control Hosp Epidemiol Date: 2017-04 Impact factor: 3.254
Authors: Monte S Willis; Bruce A Cairns; Ashley Purdy; Andrey V Bortsov; Samuel W Jones; Shiara M Ortiz-Pujols; Tina M Schade Willis; Benny L Joyner Journal: Int J Burns Trauma Date: 2013-01-24
Authors: Taylor L Watterson; Jamie A Stone; Roger Brown; Ka Z Xiong; Anthony Schiefelbein; Edmond Ramly; Peter Kleinschmidt; Michael Semanik; Lauren Craddock; Samantha Pitts; Taylor Woodroof; Michelle A Chui Journal: J Am Med Inform Assoc Date: 2021-07-14 Impact factor: 4.497
Authors: Helen Hogan; Frances Healey; Graham Neale; Richard Thomson; Charles Vincent; Nick Black Journal: Int J Qual Health Care Date: 2014-04-29 Impact factor: 2.038
Authors: John Adam Reich; Monica E Goodstein; Susan E Callahan; Kathleen M Callahan; Lindsay W Crossley; Shira I Doron; David R Snydman; Stanley A Nasraway Journal: Crit Care Date: 2015-08-14 Impact factor: 9.097
Authors: Nantasit Luangasanatip; Maliwan Hongsuwan; Direk Limmathurotsakul; Yoel Lubell; Andie S Lee; Stephan Harbarth; Nicholas P J Day; Nicholas Graves; Ben S Cooper Journal: BMJ Date: 2015-07-28