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

Published online by Cambridge University Press:  02 January 2015

Jeanmarie Mayer ,
Barbara Mooney ,
Adi Gundlapalli ,
Stephan Harbarth ,
Gregory J Stoddard ,
Michael A. Rubin ,
Louise Eutropius ,
Britt Brinton  and
Matthew H. Samore
Jeanmarie Mayer*
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Barbara Mooney
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Adi Gundlapalli
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Stephan Harbarth
Affiliation:
University of Geneva Hospitals and Medical School, Geneva, Switzerland
Gregory J Stoddard
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Michael A. Rubin
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah Salt Lake City VAMC IDEAS Center, Salt Lake City, Utah
Louise Eutropius
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Britt Brinton
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah Salt Lake City VAMC IDEAS Center, Salt Lake City, Utah
*
Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132 ([email protected])
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 59 - 66
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Pittet, D, Hugonnet, S, Harbarfh, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google Scholar
2.Won, SP, Chou, HC, Hsieh, WS, et al. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004;25:742–746.Google Scholar
3.Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005;33(7):392–397.Google Scholar
4.Pittet, D, Simon, A, Hugonnet, S, et al. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141:1–8.CrossRefGoogle ScholarPubMed
5.Kennedy, AM, Elward, AM, Fraser, VJ. Survey of knowledge, beliefs, and practices of neonatal intensive care unit healthcare workers regarding nosocomial infections, cental venous catheter care, and hand hygiene. Infect Control Hosp Epidemiol 2004;25:747–752.Google Scholar
6.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Morb Mortal Wkly Rep 2002;51(RR-16):1–45.Google Scholar
7.Larson, EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.Google Scholar
8.Association of Operating Room Nurses Recommended Practices Committee. Recommended practices: surgical hand scrubs. AORN J 1990;52: 830–836.Google Scholar
9.World Health Organization (WHO). World Alliance for Patient Safety. Global Patient Safety Challenge 2005-2006. Clean care is safer care. Geneva: WHO, 2005. http://www.who.int/patientsafety/events/05/GPSC_Launch_ENGLISH_FINAL.pdf. Accessed December 1, 2010.Google Scholar
10.Grol, R, Grimshaw, J. From best evidence to best practice: effective implementation of change in patients' care. Lancet 2003;362:1225–1230.Google Scholar
11.Erasmus, V, Daja, TJ, Brug, H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283–294.CrossRefGoogle ScholarPubMed
12.Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205–208.Google Scholar
13.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.CrossRefGoogle ScholarPubMed
14.Bischoff, WE, Reynolds, TM, Sessler, CN, et al. Handwashing compliance by health care workers. Arch Intern Med 2000;160:1017–1021.Google Scholar
15.Maury, E, Alzieu, M, Baudel, JL, et al. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am I Respir Crit Care Med 2000;162:324–327.Google Scholar
16.Naikoba, S, Hayward, A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—a systematic review. J Hosp Infect 2001;47(3):173–180.Google Scholar
17.Cockbum, J. Adoption of evidence into practice: can change be sustainable? MJA 2004;180:S66–S67.Google Scholar
18.Moulding, NT, Silagy, CA, Weller, DP. A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines. Quality in Health Care 1999;8:177–183.Google Scholar
19.Bero, LA, Grilli, R, Grimshaw, JM, et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 1998;317:465–468.Google Scholar
20.Sutton, S. Health behavior: psychosocial theories. International encyclopedia of the social and behavioral sciences. Smelser, NJ, Baltes, PB, eds. Oxford, UK: Elsevier, 2001.Google Scholar
21.O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. Am J Infect Control 2001;29:352–360.Google Scholar
22.Whitby, M, McLaws, ML, Ross, MW. Why healthcare workers don't wash their hands: a behavioral explanation. Infect Control Hosp Epidemiol 2006;27:484–492.Google Scholar
23.Raboud, J, Saskin, R, Wong, K, et al. Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers. Infect Control Hosp Epidemiol 2004;25:198–202.Google Scholar
24.Alvaran, MS, Butz, A, Larson, E. Opinions, knowledge, and self reported practices related to infection control among nursing personnel in long-term care settings. Am J Infect Control 1994;22:367–370.Google Scholar
25.Giuffrida, A, Torgerson, DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ 1997;315:703–707.Google Scholar
26.Leitenberg, H, Agras, WS, Thomson, LE. A sequential analysis of the effect of selective positive reinforcement in modifying anorexia nervosa. Behav Res Ther 1968;6:211–218.Google Scholar
27. Hand Hygiene SuperStar Nomination Form at the Johns Hopkins Hospital. http://www.hopkinsmedicine.org/heic/Hand_Hygiene/. Accessed December 1, 2010.Google Scholar
28.Carroll, CM, Gladson, SW, Camins, BC. “Your hands touch many lives”: a hand hygiene compliance improvement campaign [abstract]. Am J Infect Control 2006;34(5):E27–E28.Google Scholar
29.Grayson, ML, Jarvie, LJ, Martin, R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent statewide roll-out. Med J Aust 2008;188(11):633–640.CrossRefGoogle ScholarPubMed
30.Stone, SP, Fuller, C, Slade, R, et al. National observational study of the effectiveness of the Clean Your Hands Campaign (NOSEC) July 2004-Dec 2008: each extra mL alcohol handrub per patient-bed-day associated with a 1% drop in MRSA bacteraemia [abstract]. In: Program and ab-stracts of the ANnual Scientific Meeting of the Society for Healthcare Epidemiology of America; March, 2009; San Diego, CA.Google Scholar
31.World Health Organization (WHO). Five moments for hand hygiene. Geneva, Switzerland: WHO, 2009. http://www.who.int/gpsc/tools/Five moments/en/index.html Accessed April 2009.Google Scholar
32.Trick, WE, Vernon, MO, Welbel, SO, et al. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007;28:42–49.CrossRefGoogle ScholarPubMed
33.Larson, EL, Quiros, D, Lin, SX. Dissemination of the CDC's hand hygiene guideline and impact on infection rates. Am J Infect Control 2007;35(10): 666–675.Google Scholar
34.Blackman, D. Operant conditioning: an experimental analysis of behaviour. London, UK: Methuen, 1974.Google Scholar
35.Ouellette, JA, Wood, W. Habit and intention in everyday life: the multiple processes by which past behaviour predicts future behaviour. Psychol Bull 1998;124:54–74.Google Scholar
36.Goldman, D. System failure versus personal accountability—the case for clean hands. N Engl J Med 2006;355:121–123.Google Scholar
37.Eckmanns, T, Bessert, J, Behnke, , et al. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27(9):931–934.Google Scholar