You are not currently logged in.

Access JSTOR through your library or other institution:


Log in through your institution.

Journal Article

Sustained Improvement in Hand Hygiene Adherence: Utilizing Shared Accountability and Financial Incentives

Thomas R. Talbot MD MPH, James G. Johnson MD MPH, Claudette Fergus RN, John Henry Domenico MS, William Schaffner MD, Titus L. Daniels MD MPH, Greg Wilson MD, Jennifer Slayton RN, Nancye Feistritzer RN and Gerald B. Hickson MD
Infection Control and Hospital Epidemiology
Vol. 34, No. 11 (November 2013), pp. 1129-1136
DOI: 10.1086/673445
Stable URL:
Page Count: 8
Were these topics helpful?
See somethings inaccurate? Let us know!

Select the topics that are inaccurate.

  • Subscribe ($19.50)
  • Add to My Lists
  • Cite this Item
Sustained Improvement in Hand Hygiene Adherence: Utilizing Shared Accountability and Financial Incentives
Preview not available


Objective. To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence.Design. Time-series design with correlation analysis.Setting. Tertiary care academic medical center, including outpatient clinics and procedural areas.Participants. Medical center healthcare personnel.Methods. A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection.Results. A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase () as well as from one phase to the next (), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios ().Conclusions. Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.

Page Thumbnails