Nashville, Tenn.-based Vanderbilt University Medical Center increased hand hygiene compliance to more than 85 percent in less than two years through a multipronged initiative, according to a study in Infection Control and Hospital Epidemiology.
To improve compliance, the hospital implemented five strategies beginning in June 2009:
• Project planning. VUMC used a nine-part bundle to direct implementation of specific interventions.
• Leadership buy-in and goal setting. Leaders adopted improved hand hygiene compliance as an institutional quality improvement goal and it became a factor in their incentive compensation.
• Financial incentives. VUMC, which is self-insured for malpractice claims, included hand hygiene compliance as one of four goals in its self-insurance trust rebate program. Under the program, departments and units could receive up to 2.5 percent of malpractice premiums for meeting compliance goals.
• Expanded surveillance. From July through October 2009, VUMC expanded its hand hygiene observation program to include all inpatient and outpatient locations. Observers tracked hand hygiene events before entry and upon exit of the patient environment.
• System-wide marketing campaign. VUMC launched a marketing campaign in May 2010 that included posters and presentations to increase hand hygiene awareness and education.
In November 2010, VUMC began an active accountability phase to further improve hand hygiene adherence, which included a follow-up marketing campaign in July 2011. Other components of this phase included the following:
• An executive committee to review performance.
• Location-specific accountability interventions based on scorecards.
• Individual accountability interventions.
At baseline, from January 2007 to May 2009, average hand hygiene compliance was 52 percent. This rate increased to 75 percent during program launch, from June 2009 to October 2010, and reached 89 percent in the accountability phase, from November 2010 to August 2012. In fact, overall compliance of greater than 85 percent has been maintained since January 2011, according to the study.
In addition, hand hygiene compliance rates were inversely correlated with device-associated standardized infection ratios, which compared the actual with expected rates of all inpatient central line-associated bloodstream infections, catheter-associated urinary tract infections and intensive care unit-attributed ventilator-associated pneumonias.
Specifically, as the hand hygiene adherence rate increased, the device-associated SIRs decreased. However, the authors noted that as other healthcare-associated infection prevention initiatives were also underway, hand hygiene compliance may not be wholly responsible for the decreased SIR.
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