Transcript Hand Hygiene Compliance

Hand Hygiene Compliance
Program Overview
FY14 Quality Goal
Importance of Hand Hygiene
• Healthcare-associated infections (HAIs)-1.7
million cases per year (U.S.); 98,000 deaths
per year
• $>10 billion per year (U.S.)
• Fraction of HAIs that are preventable with
changes in hand hygiene practices not known
– 38% due to cross-transmission
– Increase in hand washing, reduction in HAIs
ASSOCIATION BETWEEN HAND HYGIENE
COMPLIANCE AND HAI RATES
Author, year
Setting
Results
Casewell, 1977
Adult ICU
Reduction HAI due to Klebsiella
Maki, 1982
Adult ICU
Reduction HAI rates
Massanari, 1984
Adult ICU
Reduction HAI rates
Kohen, 1990
Adult ICU
Trend to improvement
Doebbeling, 1992
Adult ICU
Different rates of HAI between 2 agents
Webster, 1994
NICU
Elimination of MRSA*
Zafar, 1995
Newborn
Elimination of MRSA*
Larson, 2000
MICU/NICU
85% reduction VRE
Pittet, 2000
Hospitalwide
Reduction HAI & MRSA cross-transmission
HAI, healthcare-associated infections
*Other infection control measures also instituted
Boyce JM, Pitter D. MMWR 2002;51(RR-16)
• Intervention: Improved hand hygiene, oral care,
central line care
• Outcomes: (compared to baseline period)
• Reduced HAI (Odds Ratio: 0.37 VAP, 0.42 CLABSI)
• 2.3 fewer days in hospitals per patient
• $12,000 less hospitalization costs per patient
• 2.3 percentage points lower for mortality
Indications for Hand Hygiene
BEFORE
 Direct patient contact (with or without gloves)
 Putting on sterile gloves
 Inserting a device
 Eating and drinking
AFTER
 Direct patient contact
 Removing gloves
 Contact with the patient’s environment
 Contact with body fluids, wound dressings
 Moving from a contaminated body site to a clean site
What is the Track Record on Handwashing in
Healthcare Facilities?
Average Handwashing Adherence
of Personnel in 34 Studies
90
80
70
60
50
40
30
20
10
0
• The average adherence
rate was only 40%
Study
34
31
28
25
22
19
16
13
10
7
Average
4
1
Percent Adherence
• A review of 34 published
studies of handwashing
adherence among
healthcare workers
found that adherence
rates varied from
5% to 81%
Rationale for Program
• UNC hand hygiene compliance static at 80-90%
over last several years
• Compliance historically measured only by
Infection Prevention staff and Infection Control
Liaisons
• Joint Commission requirement to show
improvement
• PICU demonstrated success with frontline staff
conducting observations and providing
immediate feedback
Hand Hygiene Program Overview
• 90% housewide compliance (inpatient areas)
– October 1-May 31 (measurement period)
– July 1-September 30 (baseline/intervention
development period)
• Clean In/Clean Out
• Observations by
– iScrub App for Apple products
– Paper forms entered in web-based survey tool
Hand Hygiene Program Overview
• All employees who enter patients’ rooms will
– Be eligible to be observed
– Be asked to provide observations
• Suggested set of 5 every month by each employee
• Minimum of 50 for an inpatient unit in a month
• Compliance data reporting
– Paper graph on each unit where observers can chart %
– Monthly reports – hospital wide by location and group
Hand Hygiene Program Overview
• Immediate feedback component
– Scripting and non-verbal reminders provided
• Rewards/Incentives
– Employees with most observations
– Departments with most unique observers
– Highest compliance by location, occupational group
• Hospital leadership involvement
– Signed letters of support
– Observations on leadership rounding