Infection Control

Hand hygiene rates improved through variety of reinforcement styles

Briefings on Infection Control, March 1, 2010

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Editor's note: This article was originally published in the December 2009 Briefings on The Joint Commission.

It takes more than one method to bring a hospital's hand hygiene compliance rate above 90%. At Barnes-Jewish St. Peters (MO) Hospital (BJSPH), it took trial and error to reach its compliance goal.

"We started collecting hand hygiene observations back in 2004," says Kathleen Dougherty, RN, MSN, manager of professional practice and leadership development at BJSPH. "We wanted to see where we were with compliance for guidelines from the Centers for Disease Control and Prevention."

What BJSPH found was not good news. Taking 100 observations per quarter, the organization found that its hand hygiene compliance rate was 57%. Conversations began on how to reach the CDC goal. The 2004 numbers illustrated the need for increased compliance; the renewed awareness alone caused a significant jump in compliance in 2005. "We got our rates up to 79% [in 2005]," Dougherty says. "This came about just based on a general heightened awareness of hand hygiene. We didn't have a pointed focus or implementation plan."

Although the jump was encouraging, it still didn’t bring the organization's compliance numbers to an acceptable level. But the organization was collecting data. The facility has seen significant rates of improvement each year since this time—remaining over 90% and at times regularly hitting 99% compliance in 2009.

Education and training
BJSPH is a member of BJC HealthCare, a 13-hospital system in Missouri. The hospitals share a center for healthcare quality and effectiveness, which works closely with all facilities to develop standards and practices to be used across the system.

"The center looks at regulations that relate to clinical quality and patient safety and assists with development of protocols and procedures to facilitate positive results," says Dougherty.

The center knew hand hygiene compliance was about to explode on the national level. At the time, The Joint Commission was increasing its focus on this issue, and BJC wanted to be prepared.

"We also knew we'd be accountable to published data [on hand hygiene compliance] on a regular basis," says Dougherty.

Thus, in 2006, mandatory training was implemented.

"Every employee was provided with training on hand hygiene in 2006," says Dougherty.

However, the increase in compliance was minimal, climbing to 80% that year. Simultaneous to the training, the organization started using hand hygiene auditors—essentially undercover agents looking for hand hygiene compliance—to act as observers.

"These auditors were on all shifts like secret shoppers," says Dougherty.
They came from all walks of hospital life—not just physicians and nurses, but secretaries, housekeepers, lab techs, and others.

When the numbers did not rise as much as expected, extra training was provided, additional auditors were trained, and compliance rates were reported at departmental meetings.

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