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Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Published online by Cambridge University Press:  02 January 2015

Jeanmarie Mayer ,
Barbara Mooney ,
Adi Gundlapalli ,
Stephan Harbarth ,
Gregory J Stoddard ,
Michael A. Rubin ,
Louise Eutropius ,
Britt Brinton  and
Matthew H. Samore
Jeanmarie Mayer*
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Barbara Mooney
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Adi Gundlapalli
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Stephan Harbarth
Affiliation:
University of Geneva Hospitals and Medical School, Geneva, Switzerland
Gregory J Stoddard
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Michael A. Rubin
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah Salt Lake City VAMC IDEAS Center, Salt Lake City, Utah
Louise Eutropius
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Britt Brinton
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah Salt Lake City VAMC IDEAS Center, Salt Lake City, Utah
*
Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132 (jeanmarie.mayer@hsc.utah.edu)
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Abstract

Objective.

To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors.

Design.

Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006).

Setting.

A 450-bed teaching tertiary-care hospital.

Interventions.

An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.

Results.

A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities; P< .001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%–84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%–81% of 4,990 opportunities during year 6 of the program.

Conclusion.

This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 59 - 66
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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