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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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References

1.Boyce, JM, Pittet, D. Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30: S1–S46.CrossRefGoogle ScholarPubMed
2.Gould, DJ, Chudleigh, JH, Moralejo, D, Drey, N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2007;2:CD005186.Google Scholar
3.Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can w. afford 100% compliance. Infect Control Hosp Epidemiol 1997;18:205–208.CrossRefGoogle Scholar
4.Pittet, D, Hugonnet, S, Harbarth, S. Infection Control Programme. Effectiveness of a hospital-wide programme to improve compliance with hand antisepsis (published correction appears i. Lancet 2000;356:2196). Lancet 2000;356:1307-1312.Google Scholar
5.Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance b. health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:1017–1021.Google Scholar
6.Marra, AR, DArco, C, de Arruda Bravim, B, et al. Controlled trial measuring the effect of a feedback intervention of hand hygiene compliance in a step-down unit. Infect Control Hosp Epidemiol 2008;29:730–735.CrossRefGoogle Scholar
7.Gawande, A. Better: A Surgeon's Notes of Performance. 1st ed. New York: Metropolitan Books; 2007.Google Scholar
8. Positive Deviance Initiative. Available at: http://www.positivedeviance.org. Accessed November 4, 2009.Google Scholar
9.Marsh, DR, Schroeder, DG, Dearden, KA, Sternin, J, Sternin, M. The power of positive deviance. BMJ 2004;329:1177–1179.CrossRefGoogle ScholarPubMed
10.Positive Deviance Initiative. MRSA eradication and prevention in the VA Pittsburgh Healthcare System (VAPHS). Available at: http://www .positivedeviance.org/projects/countries.html?id = 45. Accessed November 4, 2009.Google Scholar
11.Bruscell, P. More w. than me: how the fight against MRSA led to a new way of collaborating at Albert Einstein Medical Center. January 2008. Plexus Institute. Available at: http://www.plexusinstitute.org/ideas/show_elibrary.cfm?id = 1172. Accessed November 4, 2009.Google Scholar
12.Garner, JS, Jarvis, WR, Emori, TB, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988 (published correction appears i. Am J Infect Control 1988;16:177). Am J Infect Control 1988;6:128-140.Google Scholar
13.Miranda, DR, Nap, R, de Rijk, A, Schaufeli, W, Iapichino, G. TISS Working Group. Nursing activities score. Crit Care Med 2003;31:374–382.CrossRefGoogle ScholarPubMed
14.Bittner, MJ, Rich, EC, Turner, PD, Arnold, W Jr.Limited impact of sustained simple feedback based of soap and paper towel consumption of the frequency of hand washing in an adult intensive care unit. Infect Control Hosp Epidemiol 2002;23:120–126.CrossRefGoogle Scholar
15.Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41:77–82.Google Scholar
16.Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:1586–1591.Google ScholarPubMed
17.Rupp, ME, Fitzgerald, T, Puumala, S, et al. Prospective, controlled, crossover trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29:8–15.CrossRefGoogle ScholarPubMed
18.Sax, H, Allegranzi, B, Uçkay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.Google Scholar
19.Novoa, AM, Pi-Sunyer, T, Sala, M, Molins, E, Castells, X. Evaluation of hand hygiene adherence in a tertiary hospital. Am J Infect Control 2007;35:676–683.CrossRefGoogle ScholarPubMed
20.Whitby, M, McLaws, ML, Slater, K, Tong, E, Johnson, B. Three successful interventions in health care workers that improve compliance with hand hygiene: is sustained replication possible? Am J Infect Control 2008;36:349–355.CrossRefGoogle ScholarPubMed
21.Gawande, A. On washing hands. N Engl J Med 2004;350:1283–1286.CrossRefGoogle ScholarPubMed
22.Larson, EL, Quiros, D, Lin, SX. Dissemination of the CDC's hand hygiene guideline and impact of infection rates. Am J Infect Control 2007;35:666–675.CrossRefGoogle ScholarPubMed
23.Edwards, JR, Peterson, KD, Andrus, ML, et al; National Healthcare Safety Network Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290–301.CrossRefGoogle ScholarPubMed
24.Jarvis, WR. Infection control and changing heath-care delivery systems. Emerg Infect Dis 2001;7:170–173.CrossRefGoogle Scholar
25.Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Comparison of hospitalwide surveillance and targeted intensive care unit surveillance of healthcare-associated infections. Infect Control Hosp Epidemiol 2007;28:1361–1366.Google Scholar
26.Gould, DJ, Chudleigh, J, Drey, NS, Moralejo, D. Measuring handwashing performance in health service audits and research studies. J Hosp Infect 2007;66:109–115.CrossRefGoogle ScholarPubMed