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Sustained Improvement in Hand Hygiene Adherence: Utilizing Shared Accountability and Financial Incentives

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Thomas R. Talbot ,
James G. Johnson ,
Claudette Fergus ,
John Henry Domenico ,
William Schaffner ,
Titus L. Daniels ,
Greg Wilson ,
Jennifer Slayton ,
Nancye Feistritzer  and
Gerald B. Hickson
Thomas R. Talbot*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
James G. Johnson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
Claudette Fergus
Affiliation:
Vanderbilt University Medical Center, Nashville, Tennessee
John Henry Domenico
Affiliation:
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
William Schaffner
Affiliation:
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Greg Wilson
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
Jennifer Slayton
Affiliation:
Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
Nancye Feistritzer
Affiliation:
Vanderbilt University Medical Center, Nashville, Tennessee
Gerald B. Hickson
Affiliation:
Vanderbilt Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
*
Vanderbilt University School of Medicine, Department of Medicine, Division of Infectious Diseases, A2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232 (tom.talbot@vanderbilt.edu)
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Abstract

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Objective.

To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence.

Design.

Time-series design with correlation analysis.

Setting.

Tertiary care academic medical center, including outpatient clinics and procedural areas.

Participants.

Medical center healthcare personnel.

Methods.

A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection.

Results.

A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase (P<.0001) as well as from one phase to the next (P < .0001), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios (R2 = 0.70).

Conclusions.

Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 11 , November 2013 , pp. 1129 - 1136
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

References

1.Larson, E. A causal link between handwashing and risk of infection? examination of the evidence. Infect Control Hosp Epidemiol 1988;9(1):28–36.CrossRefGoogle ScholarPubMed
2.Boyce, JM, Pittet, D; Society for Healthcare Epidemiology of America (SHEA)/Association for Professionals in Infection Control (APICyinfectious Diseases Society of America (IDSA). Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002;51(RR-16):1–45.Google ScholarPubMed
3.McGuckin, M, Waterman, R, Govednik, J. Hand hygiene compliance rates in the United States: a one-year multicenter collaboration using product/volume usage measurement and feedback. Am J Med Qual 2009;24(3):205–213.CrossRefGoogle ScholarPubMed
4.Vanderbilt University Medical Center. Vanderbilt University Medical Center factbook, 2011-2012. http://www.mc.vanderbilt.edu/documents/main/files/2011-2012VUMCfactbook.pdf. Accessed May 22, 2013.Google Scholar
5.Hickson, GB, Moore, IN, Pichert, JW, Benegas, M. Balancing systems and individual accountability in a safety culture. In: Berman, S, ed. From Front Office to Front Line. 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources, 2012:1–36.Google Scholar
6.Pittet, D, AHegranzi, B, Boyce, J. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30(7): 611–622.CrossRefGoogle ScholarPubMed
7.Hickson, GB, Pichert, JW, Webb, LE, Gabbe, SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med 2007;82(11): 1040–1048.CrossRefGoogle ScholarPubMed
8.Hickson, GB, Federspiel, CF, Pichert, JW, Miller, CS, Gauld-Jaeger, J, Bost, P. Patient complaints and malpractice risk. JAMA 2002;287(22):2951–2957.CrossRefGoogle ScholarPubMed
9.Hickson, GB, Pichert, JW. Identifying and addressing physicians at high risk for medical malpractice claims. In: Youngberg, B, ed. Patient Safety Handbook. 2nd ed. Sudbury, MA: Jones and Bartlett Learning, 2012:347–368.Google Scholar
10.Horan, TC, Andrus, M, Dudeck, MA. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–332.CrossRefGoogle ScholarPubMed
11. R: a language and environment for statistical computing. R Foundation for Statistical Computing, 2012. http://www.R-project.org/. Accessed January 9, 2013.Google Scholar
12. Hmisc: Harrell miscellaneous. R package version 3.9, 2012. http://CRAN.R-project.org/package=Hmisc. Accessed January 9, 2013.Google Scholar
13.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299–309.CrossRefGoogle ScholarPubMed
14.Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module. Am J Infect Control 2011;39(10):798–816.CrossRefGoogle ScholarPubMed
15.Kirkland, KB, Homa, KA, Lasky, RA, Ptak, JA, Taylor, EA, Splaine, ME. Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series. BMJ Qual Saf 2012;21(12):1019–1026.CrossRefGoogle ScholarPubMed
16.Fong, KS, Fatica, C, Hall, G, et al. Impact of PCR testing for Clostridium difficile on incident rates and potential on public reporting: is the playing field level? Infect Control Hosp Epidemiol 2011;32(9):932–933.CrossRefGoogle ScholarPubMed
17.Hickson, GB, Altemeier, WA, Perrin, JM. Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study. Pediatrics 1987;80(3):344–350.CrossRefGoogle ScholarPubMed
18.Stewardson, A, Pittet, D. Quicker, easier, and cheaper? the promise of automated hand hygiene monitoring. Infect Control Hosp Epidemiol 2011;32(10):1029–1031.CrossRefGoogle ScholarPubMed
19.Polgreen, PM, Hlady, CS, Severson, MA, Segre, AM, Herman, T. Method for automated monitoring of hand hygiene adherence without radio-frequency identification. Infect Control Hosp Epidemiol 2010;31(12):1294–1297.CrossRefGoogle ScholarPubMed
20.Aboumatar, H, Ristaino, P, Davis, RO, et al. Infection prevention promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel. Infect Control Hosp Epidemiol 2012;33(2):144–151.CrossRefGoogle ScholarPubMed
21.Stewardson, A, Pittet, D. Anatomy of a successful multimodal hand hygiene campaign. BMJ Qual Saf 2012;21:973–975.CrossRefGoogle ScholarPubMed
22.Rothlisberger, FJ, Dickson, WJ. Management and the worker: an account of a research program conducted by the Western Electric Company, Hawthorne Works, Chicago. Cambridge, MA: Harvard University Press, 1939.Google Scholar
23.American Society for Healthcare Risk Management. 2012 hospital and physician professional liability benchmark analysis. October 2012. http://www.aon.com/attachments/risk-services/2012-Aon-ASHRM-Benchmark-Report-Abridged-Version.pdf. Accessed May 22, 2013.Google Scholar