Effectiveness of a Ward level target accountability strategy for hand hygiene

Abstract

BackgroundHand hygiene is a simple and effective solution in prevention of Multi Drug Resistant Organisms. Hand Hygiene campaigns have mostly taken the form of a generalised hospital approach with visual reminders and rewards for improvement in compliance. We describe a hand hygiene programme that sets an individualised ward target to increase accountability and drive improvement.MethodsWe undertook to develop a “Hand Hygiene Accountability” model, where the mean compliance rate, using the WHO hand hygiene assessment tool, for each ward over the past 6 months plus 10% was used as a target for that particular ward.Rewards were given to wards with the most percentage improvement over the year. A graded escalation was used for wards that did not meet targets based on 1,2 or 3 months of non-compliance. The most extreme action, setting up a task force directed by the Chairman of our Medical Board, would be required if 3 continuous months of non-compliance was observed. Hand Hygiene audits were performed by staff trained using the WHO audit tools. The same strategy was repeated at our community hospital.Active surveillance testing for Methicillin Resistant Staphylococcus aureus (MRSA) using nasal, groin and axilla swabs established before the project continued to be in operation, as did surveillance for hospital acquired MRSA bacteraemia (using NHSN criteria), hospital-onset Clostridioides difficile (HO-CD), and multi-resistant gram-negative bacilli.ResultsData from July 2015 to December 2017 was analysed. In the acute and community hospitals, 21,582 and 5770 hand hygiene (HH) observations were undertaken respectively.In the acute care hospital, HH compliance rates went from 65 to 78% (p-value < 0.00001). There was a reduction in MRSA bacteraemia from 5 episodes at the start of the study to 0 in 2017.In the community hospital, HH compliance improved from a mean of 64 to 75% (p-value 0.00005). MRSA transmission rate decreased from 5.72 per 1000 patient days, to 2.79 per 1000 patient days (p-value 0.00035) with an admission prevalence of 13.1% for 2016 and 20.6% in 2017.ConclusionsUsing a ward level accountability for hand hygiene is possible and can be successful in improving hand hygiene rates, possibly reducing transmission of MDROs. Realistic targets need to be set and adequate rewards and incentives provided to ensure continuous improvement.

The behaviours identified and the behaviour change techniques planned in health partnerships for antimicrobial stewardship

“…The main target behaviour of the AMS interventions related to hand washing behaviours. Changing hand washing and hand hygiene behaviour within the AMS programmes coincides with other hospital-based research that have also targeted hand hygiene and handwashing amongst professionals; justifying hand hygiene as an effective and simple resolution to the prevention of drug resistant pathogens (Pada et al, 2019). Furthermore, WHO distinguish hand hygiene as a key action for health-care workers that can prevent resistant bacteria from reaching patients (WHO, 2021).…”

The Investigation of Clinical Guidelines and Standards on Infection Control in Specialized Dental Departments

“…Developing different strategies like hand hygiene campaigns are a method to encourage healthcare workers and improve their compliance. Pada et al reported that hand hygiene accountability model increased compliance from 65% to 78% and reduced bacteremia from 5 episodes to none during their study in community hospitals [26].…”

Targeted Infection Control Practices in Japanese Hospitals for Multidrug-Resistant Organisms: Guidance From the Public Health Center

“…However, there is no recommendation on the specific content of feedback related to developing HH compliance [ 12 ]. Specific feedback programs useful for developing HH compliance have been reported [ 15 ], [ 16 ], [ 17 ]. Therefore, public health authorities and IC specialists should recommend that hospitals examine whether their provision of feedback, as currently conducted (Figure 2 ), could contribute to the development of HH compliance.…”