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

Talbot, Thomas R.; Johnson, James G.; Fergus, Claudette; Domenico, John Henry; Schaffner, William; Daniels, Titus L.; Wilson, Greg; Slayton, Jennifer M.; Feistritzer, Nancye; Hickson, Gerald B.

doi:10.1086/673445

Cited by 79 publications

(92 citation statements)

References 17 publications

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“…This is consistent with a previous study that demonstrated financial incentives were associated with modifying healthcare workers' hand hygiene practice. 21 However, we did not strictly standardize how the contest information was distributed in each participating institution and the objective assessment for changes in motivation by the contest was lacking in this study. Thus, changes in motivation by the contest with financial incentives likely varied by each participating institution.…”

Section: Discussionmentioning

confidence: 99%

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

Sakihama

Honda

Saint

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Though hand hygiene is an important method of preventing healthcare‐associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%–25%). OBJECTIVE Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence. SETTING A total of 3 to 4 inpatient wards in 3 Japanese hospitals. DESIGN Pre‐post intervention study. INTERVENTION The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals. MEASUREMENT We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre‐intervention adherence rates. RESULTS We observed 2982 postintervention provider‐patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre‐ to 33% postintervention; P < 0.001), but postintervention adherence rates varied considerably: hospital A + 29%, B + 5%, C + 8%. Hospital A won the contest with 40% adherence after the intervention. CONCLUSIONS Using a novel contest coupled with a multimodal intervention successfully improved hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary. Journal of Hospital Medicine 2016;11:199–205. © 2015 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

Sakihama

Honda

Saint

et al. 2015

Journal of Hospital Medicine

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“…34 ' 41 B. Some protocols direct observers to provide direct feedback for noncompliant observations 23 (ie, "just-in-time training") or to document the names of noncompliant individuals, 42 making the observation part of the intervention. This is appropriate to the goal of increasing hand hygiene, but adherence is likely to be inflated by the presence of an observer who is collecting names or giving feedback.…”

Section: Methods For Hand Hygiene Adherence Measurementmentioning

confidence: 99%

“…Some organizations teach the concepts of the 5 moments but simplify measurement by observing hand hygiene opportunities only before and after care (ie, the entry and exit method). 23 Many institutions in the United States have, for communication and assessment purposes, compressed the number of hand hygiene opportunities to entry to and exit from a patient care area, which roughly corresponds with the WHO's moment 1 and moment 4 or 5. Although there is some concern that this leaves out moment 2 (before an aseptic pro- cedure) and other opportunities for contamination within the patient care encounter, 20 ' 24 " 27 there is some evidence that the entry and exit method may be an adequate proxy for measurement of hand hygiene for the entire patient encounter.…”

Section: Section 2: Background -Strategies To Measure Hand Hygiene Admentioning

confidence: 99%

“…Although there is some concern that this leaves out moment 2 (before an aseptic pro- cedure) and other opportunities for contamination within the patient care encounter, 20 ' 24 " 27 there is some evidence that the entry and exit method may be an adequate proxy for measurement of hand hygiene for the entire patient encounter. 23,28 Operationally, the entry and exit method is easier to institute for measurement purposes and respects patient privacy. 23 ' 29 Emphasis on moment 1 and moment 4 (or 5) also highlights the priority for reducing cross-transmission of pathogens in health care.…”

Section: Section 2: Background -Strategies To Measure Hand Hygiene Admentioning

confidence: 99%

“…23,28 Operationally, the entry and exit method is easier to institute for measurement purposes and respects patient privacy. 23 ' 29 Emphasis on moment 1 and moment 4 (or 5) also highlights the priority for reducing cross-transmission of pathogens in health care.…”

Section: Section 2: Background -Strategies To Measure Hand Hygiene Admentioning

confidence: 99%

See 2 more Smart Citations

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

Ellingson

Haas

Aiello

et al. 2014

Infect. Control Hosp. Epidemiol.

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Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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Evaluation of Barriers to Audit-and-Feedback Programs That Used Direct Observation of Hand Hygiene Compliance

et al. 2018

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Key Points Question How have audit-and-feedback programs based on direct observations of hand hygiene compliance been implemented in real-world settings? Findings In this qualitative study of 108 hospital staff members in 10 acute care hospitals, the use of audit and feedback to improve hand hygiene compliance was problematic. Auditing by direct observation was perceived to collect inaccurate data and created tension with frontline staff, and the feedback process did not appear to encourage positive change. Meaning Strategies are needed to collect more reliable hand hygiene data and facilitate multidisciplinary collaboration toward improved hand hygiene compliance.

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

Abstract: 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.

Cited by 79 publications

References 17 publications

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

Evaluation of Barriers to Audit-and-Feedback Programs That Used Direct Observation of Hand Hygiene Compliance

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