INCREASING HAND HYGIENE COMPLIANCE BY USE OF A NOVEL HAND HELD DEVICE AT A UNIVERSITY HOSPITAL

摘要

Issue: Hand hygiene (HH) is the single most effective modality to prevent the spread of infection in healthcare.HH is also one of the most difficult quality measures to monitor. In a 722 bed tertiary referral teaching hospital,collection of accurate and timely HH compliance data on 25 inpatient units was problematic. We needed aprocess that avoided confrontation and keep secret the identity of HH surveyors to avoid compromise ofprofessional work relationships. Our solution was to employ a unique handheld device.Project: iScrub?, a hand-held application developed by The University of Iowa, was used to record compliancewith HH. Dates of intervention were January 1st – December 31st, 2011. HH observations were collected bytrained nursing volunteers and displayed on a central intranet –based database using SharePoint software?. Datawas then included in quality scorecards, and in the Infection Prevention (IP) monthly report. Episodes of noncompliancegenerated e-mail notifications with escalating consequences that might end with termination ofemployment. Multi-drug resistant organisms (MDROs) surveillance was performed by the infection preventiondepartment (IPD). HH and MDROs monthly data analysis was published on SharePoint? for stakeholders’review.Results: During the intervention we collected 26,657 observations. Average HH compliance was 95%,( averagephysician’s compliance was 88%, and average nurse’s compliance was 98%). Non-compliance occurred at asimilar frequency both before and after patient contact. Alcohol hand rub was the most frequently used method toperform HH. Physicians demonstrated the lowest compliance rates among healthcare workers. Time and date ofobservations had no effect on compliance.Lessons Learned: Shielding the identity of HH observers eliminated confrontation, and probably increased theaccuracy of collected data. Applying strict consequences for non-compliance with HH aided in increasingcompliance among staff and physicians. Publishing HH data analysis aided in increasing the compliance with HH.Data analysis identified issues related to the use of the current application and led to the creation of a new HHapplication.