Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series

Abstract

Background: Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. Objective: To improve healthcare workers' HH, and reduce healthcare-associated infections. Design: 3-year interrupted time series with multiple sequential interventions and 1-year post-intervention follow-up. Setting: Teaching hospital in rural New Hampshire. Interventions: In five categories: (1) leadership/ accountability; (2) measurement/feedback; (3) hand sanitiser availability; (4) education/training; and (5) marketing/communication. Measurement: Monthly changes in observed HH compliance (%) and rates of healthcare-associated infection (including Staphylococcus aureus infections, Clostridium difficile infections and bloodstream infections) per 1000 inpatient days. The subset of S aureus infections attributable to the operating room served as a tracer condition. We used statistical process control charts to identify significant changes. Results: HH compliance increased significantly from 41% to 87% (p<0.01) during the initiative, and improved further to 91% (p<0.01) the following year. Nurses achieved higher HH compliance (93%) than physicians (78%). There was a significant, sustained decline in the healthcare-associated infection rate from 4.8 to 3.3 (p<0.01) per 1000 inpatient days. The rate of S aureus infections attributable to the operating room rose, while the rate of other S aureus infections fell. Conclusions: Our initiative was associated with a large and significant hospital-wide improvement in HH which was sustained through the following year and a significant, sustained reduction in the incidence of healthcare-associated infection. The observed increased incidence of the tracer condition supports the assertion that HH improvement contributed to infection reduction. Persistent variation in HH

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

“…Other studies have demonstrated that the presence of leadership appeared to play a key role in improving hand hygiene adherence. 23,24 Moreover, a recent Japanese nationwide survey demonstrated higher safety centeredness was associated with regular use of standard infection prevention practice. 25 Consistent with a previous study, improving hand hygiene adherence cannot be simply achieved by improving infrastructure (eg, introduction of portable alcohol-based hand rub) alone, but it depends on altering healthcare worker behavior.…”

Infection control of Staphylococcus aureus : spa typing to elucidate transmission

“…Many studies have shown a long-term effect of hygiene interventions on compliance with hygiene guidelines (Kirkland et al 2012;Tromp et al 2012;Mernelius et al 2013c;Biswal et al 2014) whereas others have demonstrated the opposite (Gould & Chamberlain 1997). All studies reporting on a long-term effect were multimodal, whereas the study reporting no long-term effect only featured a single intervention.…”

“…The most successful way to accomplish this has proven to be by applying a multimodal hygiene intervention (Pittet et al 2000;Kirkland et al 2012;Tromp et al 2012;Mernelius et al 2013c;Biswal et al 2014). Hygiene interventions that are multidisciplinary, including all disciplines of HCWs, also physicians, also appear to be more successful (Mernelius et al 2013c).…”

“…Improved compliance with hygiene guidelines has resulted in reductions in healthcareassociated infections, healthcare-associated S. aureus infections (Kirkland et al 2012), MRSA acquisition rate and colonization pressure (Chun et al 2014) as well as the prevalence of nosocomial infections and the incidence of MRSA infections and bacteremia (Pittet et al 2000).…”

“…Hygiene interventions that are multidisciplinary, including all disciplines of HCWs, also physicians, also appear to be more successful (Mernelius et al 2013c). Attempts have been made to clarify which of the initiatives of an intervention result in the greatest improvement of compliance with hygiene guidelines (Kirkland et al 2012). This has resulted in the conclusion that a combination of initiatives is probably the key to success (Pittet et al 2000).…”