Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Abstract

Objective.To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors.Design.Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006).Setting.A 450-bed teaching tertiary-care hospital.Interventions.An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.Results.A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P< .001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%–84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%–81% of 4,990 opportunities during year 6 of the program.Conclusion.This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

Impact of observing hand hygiene in practice and research: a methodological reconsideration

“…Misleading staff is not recommended by the WHO 5 because it could promote distrust between clinicians and managers and is impossible to maintain if audit forms part of an intervention to promote hand hygiene. Covert observation in which health workers are neither informed that observation is taking place or told that other information is being documented, is not recommended for the same reason but has been employed in a number of studies 34,35 . The WHO 5 recommends two approaches to behaviour change during hand hygiene audit: unobtrusive observation and/or frequent observation to accustom staff to the presence of observers.…”

Breaking a Guinness World Record on Hand Sanitizing Relay, initiating a call for vital research in overcoming campaign fatigue for hand hygiene

“…There are however two studies published in 2014 with data on the impact beyond two years. The first by Myer et al 9 reported a significant increase of HH compliance from 22%-40% in 2000 to 65%-81% in [2003][2004][2005][2006]. Data for compliance of the different categories of healthcare workers from 2003 to 2006 were also provided and there were no increases recorded during these three years.…”

A kézhigiénés technika vizsgálata elektronikus ellenőrző berendezés segítségével 26 magyarországi betegellátó intézményben

“…A rendelkezésre álló megoldások közül, amelyek a kézhigiénés magatartást javíthatják [8,9], a leghatéko-nyabbnak az automatizált, direkt ellenőrzés és a visszacsatolás bizonyult. A digitális eszközök egyre jobban beépülnek az életünkbe, az egészségügyben is egyre nagyobb szerephez jut az elektronika.…”