Hand Hygiene Improvement and Sustainability: Assessing a Breakthrough Collaborative in Western Switzerland

Abstract

objective. To assess hand hygiene improvement and sustainability associated with a Breakthrough Collaborative.design. Multicenter analysis of hand hygiene compliance through direct observation by trained observers.setting. A total of 5 publicly funded hospitals in 14 locations, with a total of 1,152 beds, in the County of Vaud, Switzerland.participants. Clinical staff.interventions. In total, 59,272 opportunities for hand hygiene were monitored for the duration of the study, for an average of 5,921 per audit (range, 5,449-6,852). An 18-month Hand Hygiene Breakthrough Collaborative was conducted to implement the WHO multimodal promotional strategy including improved access to alcohol-based hand rub, education, performance measurement and feedback, reminders and communication, leadership engagement, and safety culture.results. Overall hand hygiene compliance improved from 61.9% to 88.3% (P < .001) over 18 months and was sustained at 88.9% (P = .248) 12 months after the intervention. Hand hygiene compliance among physicians increased from 62% to 85% (P < .001) and finally 86% at followup (P = .492); for nursing staff, compliance improved from 64% to 90% (P < .001) and finally 90% at follow-up (P = .464); for physiotherapists compliance improved from 50% to 90% (P < .001) and finally 91% at follow-up (P = .619); for X-ray technicians compliance improved from 45% to 80% (P < .001) and finally 81% at follow-up (P = .686). Hand hygiene compliance also significantly increased with sustained improvement across all hand hygiene indications and all hospitals.conclusions. A rigorously conducted multicenter project combining the Breakthrough Collaborative method for its structure and the WHO multimodal strategy for content and measurement was associated with significant and substantial improvement in compliance across all professions, all hand hygiene indications, and all participating hospitals.

Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections

“…26,36,37 Our experience with this program reinforced the findings of other studies that a multimodal, team-driven, friendly competition and positive-reinforcement-focused approach is crucial for improving hand hygiene, particularly with respect to peer influence and role modeling. 11,12,28,29,38 It also reflects the assertion outlined in other studies that multimodal interventions are necessary for sustained improvement. 26,39,40 Easing concerns about the system's accuracy and increasing comfort were important considerations.…”

“…26 Interventions that are associated with improved adherence include providing feedback, rewarding positive behavior, encouraging friendly competition, and conducting educational programs to raise awareness. [26][27][28][29][30] Our institution implemented an RFID-based AHHMS in selected units, coupled with interventions designed to increase hand hygiene adherence. We assessed hand hygiene adherence both electronically and by direct observation, and we studied the effect of AHHMS-measured adherence on HAI rates.…”

Hand hygiene initiative: comparative study of pre- and postintervention outcomes

“…The absence of leadership engagement in this study could also have been partially responsible for the modest improvement. Effective leadership involvement can improve hand hygiene compliance (25,26). Continuing efforts and further interventions are needed to address such issues.…”

“…Absence of leadership has been linked with loss of sustainable change in hand hygiene compliance (34). Other studies have shown that inclusion of administrative leadership is linked with improvements in hand hygiene compliance rates and most importantly with enhanced sustainability of such improvements (25,26).…”

Battling Entropy in Infection Control Systems

“…In this issue of Infection Control and Hospital Epidemiology , Dr Staines et al 2 present the results of a well-organized, multifaceted, 18-month hand hygiene improvement collaborative project with a 12-month postimplementation assessment. A consortium of 5 Swiss hospitals participated, each setting up implementation teams that focused on systems optimization, education, data collection and feedback, leadership, and “sustainability engineering,” a set of interventions aimed at maintaining the effect of their interventions after the project was completed.…”