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Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel

Published online by Cambridge University Press:  02 January 2015

Hanan Aboumatar ,
Polly Ristaino ,
Richard O. Davis ,
Carol B. Thompson ,
Lisa Maragakis ,
Sara Cosgrove ,
Beryl Rosenstein  and
Trish M. Perl
Hanan Aboumatar*
Affiliation:
Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, Maryland Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Polly Ristaino
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Richard O. Davis
Affiliation:
Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, Maryland
Carol B. Thompson
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Lisa Maragakis
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Sara Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Beryl Rosenstein
Affiliation:
Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
*
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, 601 North Caroline Street, Suite 2080, Baltimore, MD 21287 (habouma1@jhmi.edu)
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Abstract

Background.

Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.

Objective.

To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.

Design.

Time series design.

Setting

Our study was conducted at a tertiary care academic center.

Participants.

Hospital healthcare personnel.

Methods.

We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by “undercover” observers.

Results.

Overall hand hygiene compliance increased by 2-fold after full program implementation (P<.001), and this increase was sustained over a 20-month follow-up period (P< .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53–4.23; P< .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P<.001), from 38% to 62% among medical providers (P<.001), and from 27% to 75% among environmental services staff (P<.001).

Conclusions.

Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.

Infect Control Hosp Epidemiol 2012;33(2):144-151

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 144 - 151
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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