QAPI 118 - Can Achieving High Hand Hygiene Compliance in the Hospital Be Sustainable, Reliable, and Affordable?

Background: Hand hygiene is the most important measure for preventing hospital acquired infections. Despite decades of research, hospitals still struggle with hand hygiene compliance. We sought to overcome common barriers with a new, more effective program, using existing resources.

Methods: Prior to 2018, our hospital used a direct observer program for hand hygiene monitoring. Limitations included low baseline compliance, the Hawthorn effect, limited improvement, and being resource intensive. In 2018, we implemented a program where trained light duty nursing staff perform observations using security camera live feeds in inpatient units and the emergency department. Observers were given standardized training with observer comparisons and feedback to improve inter-rater reliability. Observers provided real-time feedback and acted as hand hygiene champions upon return to their units. Results were shared monthly with leadership and frontline staff, highlighting areas for improvement as well as top performers. In June 2023, we made program updates, including adding specific non-compliant behaviors by unit and sharing monthly education on specific behaviors with greater detail in spreadsheet form.

Results: From a baseline of 40.2%, hand hygiene rose to 78.4% in 2018 during the first year of the program. Compliance remained steady (mean 78.9%, median 79.7%) through the first half of 2023. Following the program update in June 2023, hand hygiene compliance rose to 92.7% over the next six months (mean 89.1%, median 88.6%), during which time we have seen all but one hospital acquired infection rate decline. From January through November 2023, eight staff members collected over 32,000 observations, including nights and weekends, which has been sustainable.

Conclusions: Hospitals can develop a sustainable, reliable hand hygiene program and achieve high compliance with the use of existing resources.