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Author: Day, C. (2009) Source: Day, C. Engaging the Nursing Workforce, Nursing Administration Quarterly, July/September 2009, Vol. 33, No. 3

STUDY

Day, C. (2009)

Evidence-based multimodal hand hygiene intervention increases compliance from 45 % to 85 %

Background: Nosocomial infection is one of the significant risks during hospital stays. Contaminated hands of healthcare workers are an important transmission path here. Hence, efficient hand hygiene is important for the health and safety of the patients. The compliance rate is, however, lower than 50 % in many hospitals. in 2006, the compliance of the Stanford Hospital & Clinics (SHC) employees was below 20 % – thanks to an offensive campaign, it could be increased to 45 %. This suboptimal initial situation served as motivation to conduct a continuative intervention.


Methods: Based on a literature research and analysis of intervention studies published between 2000 and 2007, Day developed recommendation guidelines for improving hand hygiene. The guidelines comprised the following recommendations:

  1. Implement a hand hygiene programme or campaign to raise the employees’ and patients’ awareness of hand hygiene.
  2. Train employees on hand hygiene protocols and techniques.
  3. Monitor and provide feedback on employees’ hand hygiene behaviour.
  4. Select and provide products for alcohol-based hand disinfection and skin care.
  5. Involve the management to support and promote hand hygiene.

Based on this and together with a team of executives, hygiene and quality experts, a compliance target of 90 % was defined and interventions were developed for each point of the guidelines. The following interventions were then implemented in SHC over a period of four months:

  1. Campaign and management: In addition to posters that were especially designed for the campaign and hung up in the hospital, all employees signed a “hand hygiene promise” affirming their commitment. The managers of each ward supported the campaign by regular checks and monthly “calls to action” to promote a cultural change to achieve better hand hygiene. Additionally, hand hygiene became an agenda item for all meetings.
  2. Training and feedback: Hygiene experts conducted controls and demonstrations with agar plates and fluorescent hand disinfectant. The compliance was measured by hidden observers before, during and after the intervention. The results of the compliance observations as well as the data on MRSA infections were published at monthly meetings.
  3. Product availability: Alcohol-based hand disinfectants were already used before the intervention. Previously, dispensers were mainly installed at doors of patient rooms. On request of the employees, additional hand disinfectant dispensers were installed, additional standalone dispensers were distributed throughout the facility strategically. The individual wards tested differing hand disinfectants and could choose a favourite product.

Results: Within the first six months of the multimodal intervention, the average hand hygiene compliance of the employees at SHC increased from 45 % to 85 %. Nurses had the highest compliance rate (90 %), followed by physicians (85 %) and other employees (79 %).


Conclusions: The study results show that a multimodal intervention can improve the hand hygiene compliance. Day concludes that – based on evidence-based recommendations – it is possible to develop facility-specific approaches and thus improve the hand hygiene culture.


Source:
Day, C. Engaging the Nursing Workforce, Nursing Administration Quarterly, July/September 2009, Vol. 33, No. 3


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