“Your Hands Touch Many Lives”: A Hand Hygiene Compliance Improvement Campaign

BACKGROUND/OBJECTIVES: Studies have shown that antibiotic-resistant organisms can be transmitted from patient to patient through the hands of healthcare workers (HCW). Hand antisepsis, when performed properly, has been shown to reduce the incidence of healthcare-associated infections. Adherence of HCWs to hand hygiene (HH) policy, as reported in the literature, has only been about 40%. We established a multidisciplinary HH promotional campaign since this has been shown in the literature to be effective in increasing adherence rates. METHODS: Beginning in the 2nd quarter (qtr) of 2003, multiple interventions were initiated to promote HH compliance. The first intervention was an interactive education program based on CDCʹs Hand Hygiene Guidelines in which 95% (430/451) of the employees participated. The second intervention was positive reinforcement (reward given on the spot) given to the employee if they were observed by the infection control specialist (ICS) to adhere to the hand hygiene policy. The third intervention was displaying posters/flyers with HH themes and key physician leaders and employees as HH advocate models. The final intervention was an ice cream party attended by the hospital administrator celebrating the increase in HH adherence rates for all the staff. HH compliance was measured by unobserved observations by the ICP and a clandestine employee representatives. HCWs were only observed after contact with the patient or the patientʹs environment. Quarterly feedbacks were also provided to all departments. RESULTS: Hospital-wide HH compliance rate at the start of the program was 34% (41/119). The HH compliance rate increased to 53% (113/214) [RR 1.51 ; P < 0.001] after the second intervention. The third intervention (poster/flyer) resulted in a HH compliance rate of 62% (126/204) [RR 1.76; P < 0.001]. The fourth intervention (administration support) resulted in a compliance rate of 72% (128/178) [RR 2.05; P < 0.001]. Alcohol foam use increased from 322 ounces/1000 patient days in 2003 to 629 ounces/1000 patient days in 2004 (P < 0.001). CONCLUSIONS: Continued emphasis and awareness of HH using multiple interventions resulted in sustained improvement of compliance rates (34% vs. 72%; RR 2.05; P < 0.001). The volume of alcohol foam use is also an ideal surrogate marker for observed compliance with HH policy. Key components of this multidisciplinary campaign were the hospital administration support, positive reinforcement, and performance feedback.