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Am J Infect Control. 2013 Oct;41(10):e101-5. doi: 10.1016/j.ajic.2013.01.031. Epub 2013 May 2.

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

Author information

1
Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Division of Infectious Disease, Children's National Medical Center, Washington, DC. Electronic address: xsong@cnmc.org.

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.

KEYWORDS:

Cost; Hand washing; MRSA

PMID:
23643451
DOI:
10.1016/j.ajic.2013.01.031
[Indexed for MEDLINE]
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