Improving hand hygiene compliance in health care workers: Strategies and impact on patient outcomes

Xiaoyan Song, David C. Stockwell, Tara Floyd, Billie L. Short, Nalini Singh

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We described a systematic process for improving hand hygiene (HH) compliance in health care providers and assessed the impact of HH on patient outcomes. Methods: This retrospective cohort study was conducted between July 2008 and September 2011 in a children's hospital. We employed failure mode effectiveness analysis to identify barriers for complying with HH requirements and instituted improvement measures. We conducted a subanalysis using methicillin-resistant Staphylococcus aureus (MRSA) acquisition data and HH compliance data collected in the neonatal intensive care unit (NICU) to demonstrate the impact of HH on patient outcomes. Results: The overall HH compliance rate increased from 50.3% preintervention (July 2008-September 2008) to 84.0% postintervention (January 2009-September 2011) (relative risk [RR], 1.7; 95% confidence interval [CI]: 1.6-1.9). Compliance among physicians and nurses increased from 48.6% to 87.0% (RR, 1.4; 95% CI: 1.3-1.6) and from 46.5% to 77.9% (RR, 1.3; 95% CI: 1.2-1.4), respectively. Sustaining HH at 80% or higher was associated with a 48% further reduction of MRSA acquisition (incident rate ratio, -0.52; 95% CI: -0.31 to -0.90) in a unit that had comprehensive MRSA prevention measures. This reduction represents the prevention of 1.3 MRSA acquisitions per month, resulting in a saving of 11.6 NICU-days and $66,397 hospital charges. Conclusion: This study demonstrated the utility of failure mode effectiveness analysis to improve staff HH and suggested HH as a potential cost-effective means for preventing MRSA in hospitals.

Original languageEnglish (US)
Pages (from-to)e101-e105
JournalAmerican Journal of Infection Control
Volume41
Issue number10
DOIs
StatePublished - Oct 2013
Externally publishedYes

Keywords

  • Cost
  • Hand washing
  • MRSA

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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