QAPI 120 - Clean Hands Protect Fragile Lives: Hand Hygiene in the Neonatal Intensive Care Unit

Background: Neonates are high-risk patients who are more susceptible to Healthcare-Acquired Infections (HAIs). Our hospital has two different physical layouts in our Special Care Nursery (SCN), a newly remodeled or “new” Neonatal Intensive Care Unit (NICU), and an “old” Neonatal Intermediate Care Unit (NIMCU), both of which have differing layouts and workflows. The team chose to focus on hand hygiene compliance after performing reviews on multiple HAIs and discovering that hand hygiene barriers were present.

Methods: The team conducted assessments of the SCN, including a spaghetti diagram assessing movement studies, staff surveys on their perception of hand hygiene compliance, as well as unit based and secret shoppers for auditing compliance. Based on this investigation, a hand hygiene campaign was introduced that was tailored specifically to the NICU. This campaign included slogans, visual aids, and posters. NICU staff also completed a "color assessment" to determine which colors were most associated with positive emotions, which outlined visual aids. The team conducted compliance audits before and after the intervention.

Results: Hand hygiene compliance was measured in the SCN areas over a 4-week period before (Baseline) and 4-week period after the intervention. In the 4-week period following the intervention, hand hygiene compliance increased from 13.7% to 38.6% in the NICU and from 27.9% to 44.9% in the NIMCU.

Conclusions: The modest effectiveness of placards may have been due to many factors, including increasing volumes due to the COVID-19 (Coronavirus Infectious Disease-19) pandemic surge and staffing challenges. However, due to the success with behavior modification techniques such as these, the team plans to rotate the placards on a routine basis to draw the attention back to the dispensers and continue to monitor as well as provide other methods of hand hygiene product availability to ensure the team is set up for success in all layouts of the SCN.