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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
Published by: Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Stable URL: http://www.jstor.org/stable/10.1086/673445
Page Count: 8
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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.
© 2013 by The Society for Healthcare Epidemiology of America. All rights reserved.