A Staines1, P Vanderavero2, B Duvillard2, P Deriaz2, P Erard2, F Kundig3, C Juillet4, O Clerc2. 1. Institute for Education and Research on Social and Health Organizations, University of Lyon 3, Lyon, France. Electronic address: anthony.staines@bluewin.ch. 2. Infection Prevention and Control Unit, Hôpital Neuchâtelois, Neuchâtel, Switzerland. 3. Clinical Quality and Patient Safety Unit, Hôpital Neuchâtelois, Neuchâtel, Switzerland. 4. Internal Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland.
Abstract
BACKGROUND: Evidence of sustained improvement in hand hygiene compliance at the institutional level is scarce. AIM: To assess the impact and sustainability of a hospital-wide improvement programme on hand hygiene compliance of staff. METHODS: Analysis of trends of hand hygiene compliance for all clinical staff, measured through direct observation by trained observers, within a 450-bed multi-centre teaching hospital in the county of Neuchâtel, Switzerland. INTERVENTION: Implementation of a multi-modal improvement programme based on the World Health Organization (WHO) strategy, with the goal of reaching overall compliance of at least 80%. The strategy content included increasing access to alcohol hand rub; healthcare worker education; two-month interval compliance measurement; and hospital-wide open communication about ward-level results, point-of-care reminders, communication via a dedicated in-house newsletter and leadership engagement. The implementation phase was followed by a consolidation phase. FINDINGS: In total, 33,476 observations were collected from September 2012 to March 2014 (mean >3000 opportunities per audit). Overall compliance improved from 61.4% at baseline to 83.6% after the 18-month improvement programme (P<0.001), and was sustained at 85.3% 18 months later (i.e. 18 months after the programme finished) (P=0.08). The same trend (significant and clinically relevant improvement during the intervention, sustained after 18 months) was measured for all professional categories. CONCLUSIONS: This WHO-inspired improvement programme was associated with a significant improvement in hand hygiene compliance, globally and for each professional category. The results were sustained over an 18-month period.
BACKGROUND: Evidence of sustained improvement in hand hygiene compliance at the institutional level is scarce. AIM: To assess the impact and sustainability of a hospital-wide improvement programme on hand hygiene compliance of staff. METHODS: Analysis of trends of hand hygiene compliance for all clinical staff, measured through direct observation by trained observers, within a 450-bed multi-centre teaching hospital in the county of Neuchâtel, Switzerland. INTERVENTION: Implementation of a multi-modal improvement programme based on the World Health Organization (WHO) strategy, with the goal of reaching overall compliance of at least 80%. The strategy content included increasing access to alcohol hand rub; healthcare worker education; two-month interval compliance measurement; and hospital-wide open communication about ward-level results, point-of-care reminders, communication via a dedicated in-house newsletter and leadership engagement. The implementation phase was followed by a consolidation phase. FINDINGS: In total, 33,476 observations were collected from September 2012 to March 2014 (mean >3000 opportunities per audit). Overall compliance improved from 61.4% at baseline to 83.6% after the 18-month improvement programme (P<0.001), and was sustained at 85.3% 18 months later (i.e. 18 months after the programme finished) (P=0.08). The same trend (significant and clinically relevant improvement during the intervention, sustained after 18 months) was measured for all professional categories. CONCLUSIONS: This WHO-inspired improvement programme was associated with a significant improvement in hand hygiene compliance, globally and for each professional category. The results were sustained over an 18-month period.
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