Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series
Open Access
- 21 July 2012
- journal article
- research article
- Published by BMJ in BMJ Quality & Safety
- Vol. 21 (12), 1019-1026
- https://doi.org/10.1136/bmjqs-2012-000800
Abstract
Background Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. Objective To improve healthcare workers' HH, and reduce healthcare-associated infections. Design 3-year interrupted time series with multiple sequential interventions and 1-year post-intervention follow-up. Setting Teaching hospital in rural New Hampshire. Interventions In five categories: (1) leadership/accountability; (2) measurement/feedback; (3) hand sanitiser availability; (4) education/training; and (5) marketing/communication. Measurement Monthly changes in observed HH compliance (%) and rates of healthcare-associated infection (including Staphylococcus aureus infections, Clostridium difficile infections and bloodstream infections) per 1000 inpatient days. The subset of S aureus infections attributable to the operating room served as a tracer condition. We used statistical process control charts to identify significant changes. Results HH compliance increased significantly from 41% to 87% (pS aureus infections attributable to the operating room rose, while the rate of other S aureus infections fell. Conclusions Our initiative was associated with a large and significant hospital-wide improvement in HH which was sustained through the following year and a significant, sustained reduction in the incidence of healthcare-associated infection. The observed increased incidence of the tracer condition supports the assertion that HH improvement contributed to infection reduction. Persistent variation in HH performance among different groups requires further study.Keywords
This publication has 31 references indexed in Scilit:
- A Multifaceted Approach to Education, Observation, and Feedback in a Successful Hand Hygiene CampaignThe Joint Commission Journal on Quality and Patient Safety, 2011
- Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital CareInfection Control & Hospital Epidemiology, 2010
- Hand Hygiene Compliance Rates in the United States—A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement and FeedbackAmerican Journal of Medical Quality, 2009
- Evidence-based model for hand transmission during patient care and the role of improved practicesThe Lancet Infectious Diseases, 2006
- 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 ForceInfection Control & Hospital Epidemiology, 2002
- The effectiveness of interventions aimed at increasing handwashing in healthcare workers - a systematic reviewJournal of Hospital Infection, 2001
- Effectiveness of a hospital-wide programme to improve compliance with hand hygieneThe Lancet, 2000
- A Causal Link Between Handwashing and Risk of Infection? Examination of the EvidenceInfection Control & Hospital Epidemiology, 1988
- Hand-Washing Patterns in Medical Intensive-Care UnitsThe New England Journal of Medicine, 1981
- Transmission of Staphylococci Between NewbornsAmerican Journal of Diseases of Children, 1962