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Positive Deviance A New Strategy for Improving Hand Hygiene Compliance

Published online by Cambridge University Press:  02 January 2015

Alexandre R. Marra ,
Luciana Reis Guastelli ,
Carla Manuela Pereira de Araújo ,
Jorge L. Saraiva dos Santos ,
Luiz Carlos R. Lamblet ,
Moacyr Silva Jr ,
Gisele de Lima ,
Ruy Guilherme Rodrigues Cal ,
Ângela Tavares Paes  and
Miguel Cendoroglo Neto
...Show all authors
Alexandre R. Marra*
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Luciana Reis Guastelli
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Carla Manuela Pereira de Araújo
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Jorge L. Saraiva dos Santos
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Luiz Carlos R. Lamblet
Affiliation:
Infection Control Unit, Sao Paulo, Brazil
Moacyr Silva Jr
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Gisele de Lima
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Ruy Guilherme Rodrigues Cal
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
Ângela Tavares Paes
Affiliation:
Hospital Israelita Albert Einstein, the Statistics Department, Instituto Israelita de Ensino e Pesquisa, Sao Paulo, Brazil
Miguel Cendoroglo Neto
Affiliation:
Division of Medical Practice, Sao Paulo, Brazil
Luciana Barbosa
Affiliation:
Gojo Latin America, Sao Paulo, Brazil
Michael B. Edmond
Affiliation:
Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Oscar Fernando Pavão dos Santos
Affiliation:
Intensive Care Unit, Sao Paulo, Brazil
*
Avenue Albert Einstein, 627/701, Intensive Care Unit, Hospital Israelita Albert Einstein, 5th Floor, Morumbi, Sao Paulo 05651-901, Brazil ([email protected])
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Extract

Objective.

To evaluate the effectiveness of a positive deviance strategy for the improvement of hand hygiene compliance in 2 adult step-down units.

Design.

A 9-month, controlled trial comparing the effect of positive deviance on compliance with hand hygiene.

Setting.

Two 20-bed step-down units at a tertiary care private hospital.

Methods.

The first phase of our study was a 3-month baseline period (from April to June 2008) in which hand hygiene episodes were counted by use of electronic handwashing counters. From July to September 2008 (ie, the second phase), a positive deviance strategy was implemented in the east unit; the west unit was the control unit. During the period from October to December 2008 (ie, the third phase), positive deviance was applied in both units.

Results.

During the first phase, there was no statistically significant difference between the 2 step-down units in the number of episodes of hand hygiene per 1,000 patient-days or in the incidence density of healthcare-associated infections (HAIs) per 1,000 patient-days. During the second phase, there were 62,000 hand hygiene episodes per 1,000 patient-days in the east unit and 33,570 hand hygiene episodes per 1,000 patient-days in the west unit (P < .01). The incidence density of HAIs per 1,000 patient-days was 6.5 in the east unit and 12.7 in the west unit (P = .04). During the third phase, there was no statistically significant difference in hand hygiene episodes per 1,000 patient-days (P = .16) or in incidence density of HAIs per 1,000 patient-days.

Conclusion.

A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of HAIs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 12 - 20
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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