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Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study

Published online by Cambridge University Press:  02 November 2020

Jerome Leis
Affiliation:
University of Toronto
Jeff Powis
Affiliation:
Michael Garron Hospital, Toronto, Ontario, Canada
Allison McGeer
Affiliation:
Mount Sinai Hospital
Daniel Ricciuto
Affiliation:
Lakeridge Health, Oshawa, Ontario, Toronto
Tanya Agnihotri
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Natalie Coyle
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Victoria Williams
Affiliation:
Sunnybrook Health Sciences Centre
Christine Moore
Affiliation:
Sinai Health System, Toronto, Ontario, Canada
Natasha Salt
Affiliation:
Sunnybrook Health Sciences Center
Louis Wong
Affiliation:
Sinai Health System
Liz McCreight
Affiliation:
Sinai Health System, Toronto, Ontario, Canada
Sajeetha Sivaramakrishna
Affiliation:
Michael Garron Hospital, Toronto, Ontario, Canada
Shara Junaid
Affiliation:
St Michael’s Hospital
Xingshan Cao
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Matthew Muller
Affiliation:
Unity Health, Toronto, Ontario, Canada
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Abstract

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Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Our goal was to assess the impact of group electronic monitoring coupled with unit-led quality improvement on HH performance and prevention of healthcare-associated transmission and infection. Methods: A stepped-wedge cluster randomized quality improvement study was undertaken across 5 acute-care hospitals in Ontario, Canada. Overall, 746 inpatient beds were electronically monitored across 26 inpatient medical and surgical units. Daily HH performance as measured by group electronic monitoring was reported to inpatient units who discussed results to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (%) between baseline and intervention. Secondary outcomes included transmission of antibiotic resistant organisms such as methicillin resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. Results: After adjusting for the correlation within inpatient units, there was a significant overall improvement in HH adherence associated with the intervention (IRR, 1.73; 95% CI, 1.47–1.99; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1,395,450 of 4,544,144) to 37% (598,035 of 1,536,643) within 1 month, followed by consecutive incremental increases up to 53% (804,108 of 1,515,537) by 10 months (P < .0001). We identified a trend toward reduced healthcare-associated transmission of MRSA (0.74; 95% CI, 0.53–1.04; P = .08). Conclusions: The introduction of a system for group electronic monitoring led to rapid, significant, and sustained improvements in HH performance within a 2-year period.

Funding: None

Disclosures: None

Type
Oral Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
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