An Organizational Climate Intervention Associated With Increased Handwashing and Decreased Nosocomial Infections

Abstract

Handwashing practices are persistently suboptimal among healthcare professionals and are also stubbornly resistant to change. The purpose of this quasi-experimental intervention trial was to assess the impact of an intervention to change organizational culture on frequency of staff handwashing (as measured by counting devices inserted into soap dispensers on four critical care units) and nosocomial infections associated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). All staff in one of two hospitals in the mid-Atlantic region received an intervention with multiple components designed to change organizational culture; the second hospital served as a comparison. Over a period of 8 months, 860,567 soap dispensings were recorded, with significant improvements in the study hospital after 6 months of follow-up. Rates of MRSA were not significantly different between the two hospitals, but rates of VRE were significantly reduced in the intervention hospital during implementation.

Hand Hygiene

“…60,217,334,429,485,486,613,648,651,663,666,667,670,680,682,684,686,687,713,714,803,804,851,852 Recent studies have further enriched the scientific literature. 140,428,493,494,655,657,694,698,699,701,705,[707][708][709][710][715][716][717][718]728,853 In general, most studies differed greatly in their duration and intervention approach.…”

“…The value of active participation at the institutional level and its impact on HCWs' compliance with hand hygiene have been demonstrated in several studies. 60,651,713 Patterns of hand hygiene both in the community and in health care represent a complex, socially entrenched and ritualistic behaviour. It is thus not surprising that single interventions have failed to induce a sustained improvement in HCW behaviour.…”

“…Despite different methodologies, most interventions have been associated with an increase in hand hygiene compliance, but a sustainable improvement demonstrated by a followup evaluation of two years or more after implementation has rarely been documented. 60,490,494,657,714,715,717,718 Most studies used multiple strategies, which included: HCWs' education, 60,140,334,429,485,486,613,651,663,666,667,670,676,682,684,686,687,698,705,707,708,713,716,717,813,814,819,834,851 performance feedback, 60,334,485,486,651,657,663,666,667,670,…”

“…60,713,725,789 It involves a combination of education, motivation, and system change. 789 Wide dissemination of hand hygiene guidelines alone is not sufficient motivation for a change in hand hygiene behaviour.…”

“…Few studies reported sustained improvement as a consequence of the long-running implementation of programmes aimed at promoting optimal adherence to hand hygiene policies. 60,494,657,[713][714][715][716][717][718][719] …”