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Testing a novel audit and feedback method for hand hygiene compliance: A multicenter quality improvement study

Published online by Cambridge University Press:  15 November 2018

Aaron M. Scherer
Affiliation:
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
Heather Schacht Reisinger
Affiliation:
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
Michihiko Goto
Affiliation:
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
Cassie Cunningham Goedken
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
Gosia S. Clore
Affiliation:
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
Alexandre R. Marra
Affiliation:
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
Emily E. Chasco
Affiliation:
Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
Charlesnika T. Evans
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr Veterans Affairs Hospital, Chicago, Illinois, United States Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Michael A. Rubin
Affiliation:
Salt Lake Veterans Affairs Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, Salt Lake City, Utah, United States Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
Eli N. Perencevich
Affiliation:
Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
Corresponding
E-mail address:

Abstract

Objective

Although most hospitals report very high levels of hand hygiene compliance (HHC), the accuracy of these overtly observed rates is questionable due to the Hawthorne effect and other sources of bias. In the study, we aimed (1) to compare HHC rates estimated using the standard audit method of overt observation by a known observer and a new audit method that employed a rapid (<15 minutes) “secret shopper” method and (2) to pilot test a novel feedback tool.

Design

Quality improvement project using a quasi-experimental stepped-wedge design.

Setting

This study was conducted in 5 acute-care hospitals (17 wards, 5 intensive care units) in the Midwestern United States.

Methods

Sites recruited a hand hygiene observer from outside the acute-care units to rapidly and covertly observe entry and exit HHC during the study period, October 2016–September 2017. After 3 months of observations, sites received a monthly feedback tool that communicated HHC information from the new audit method.

Results

The absolute difference in HHC estimates between the standard and new audit methods was ~30%. No significant differences in HHC were detected between the baseline and feedback phases (OR, 0.92; 95% CI, 0.84–1.01), but the standard audit method had significantly higher estimates than the new audit method (OR, 9.83; 95% CI, 8.82–10.95).

Conclusions

HHC estimates obtained using the new audit method were substantially lower than estimates obtained using the standard audit method, suggesting that the rapid, secret-shopper method is less subject to bias. Providing feedback using HHC from the new audit method did not seem to impact HHC behaviors.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Scherer AM, et al. (2019) Testing a novel audit and feedback method for hand hygiene compliance: A multicenter quality improvement study. Infection Control & Hospital Epidemiology 2019, 40, 89–94. doi: 10.1017/ice.2018.277

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