Hand Hygiene- A Novel Approach?

Here is a journal article recently published in the American Journal of Infection Control.
There is little disagreement in healthcare regarding the importance of hand hygiene. The question remains, how can hand hygiene efforts be both promoted and sustained? Some have argued for electronic surveillance, others have found answers in positive deviance, some have even turned to psychological motivators. We have successfully implemented a hand hygiene program using roaming, trained hand hygiene observers and data collectors.

The authors of this study created small teams consisting of a representative from Quality Assessment, an Infection Prevention Practitioner, and staff from a particular unit. Teams identified barriers to hand hygiene success. Next, the teams set their own goals for hand hygiene compliance. Using the WHO guidelines for hand hygiene, teams diagrammed detailed workflows for several of their most common patient care tasks. Wherever hand hygiene was indicated, the workflow was marked with a number corresponding to one or more of the WHO’s “5 moments for hand hygiene.” At the end of the 12-week period, staff members were trained to observe each other and began officially collecting and submitting data to Infection Prevention.

Between 2006 and 2008, the institutional hand hygiene compliance was 60%-70%. After the new program was launched in 2008, compliance increased to 97% and was reportedly sustained. 

So hospital units were empowered to promote and perform hand hygiene surveillance, after identifying unit specific barriers and opportunities for hand hygiene.  Isn't this another spin on positive deviance?  Is it really all that novel? A few concerns arise. Data on hand hygiene compliance observation was sparse, with no reported numerator and denominator. Only employees on day shift were observed. No doubt that, with intensive hand hygiene observation, the Hawthorne Effect was at play, especially for the day shift crew. These may have skewed the positive results of the study.

In the end, whatever intervention is reasonable, feasible and acceptable for sustaining hand hygiene should be given consideration for implementation. 


Give it a go.