Improving the Culture
of Hand Hygiene
Deborah Scott RN, Infection Prevention QI Specialist
Improving the
Culture of Hand
Hygiene Using
Teamwork and
Transparency
with Leadership
Engagement
Effective Hand Hygiene
Saves Lives
”Leadership plays a critical role in hospital infection
prevention and control programs”
— Infection Control and Hospital Epidemiology
Effective Hand Hygiene
Saves Lives
Successful hospitals:
• Cultivate a culture of clinical excellence and
effectively communicate it to staff
• Focus on overcoming barriers and deal directly
with resistant staff or process issues
• Inspire their employees
Saint, et al. (2010)
Conclusion
Leadership plays a key role in infection prevention.
The challenging process of translating the findings
of infection prevention research into practice can
be eased by leaders who heed the advice and
experiences of their colleagues
Reference: Saint SS, Kowalski CP, Banaszak‐Holl J, Forman J, Damschroder L and Krein SL. The Importance of Leadership in Preventing
Healthcare‐Associated Infection: Results of a Multisite Qualitative Study. Infect Control Hosp Epidemiol. 2010;31:901-907
in
Citywide Hand Hygiene Initiative
Triggers 25% Drop in Community Infection Rate
(Jonesboro’s My Healthy Arkansas Initiative)
My Healthy Arkansas Initiative
Effective Hand Hygiene
Saves Lives
• Healthcare workers’ unclean hands are the #1
source of germ transmission and healthcareassociated infections
• 2 million people in the U.S. contract a HAI each
year resulting in 99,000 deaths
• Preventable infections cause more deaths than
AIDS, breast cancer, and auto accidents
combined
• TN: 6 out of every 100 patients are colonized or
infected with MRSA
Effective Hand Hygiene
Saves Lives
• University of Geneva Hospital
– 40% HAI reduction
• Presbyterian Healthcare Services
– 51% MRSA reduction; savings = $276,500
Effective Hand Hygiene
Saves Lives
Despite such a simple step (implementation
of a hand hygiene initiative), the compliance
rate in the U.S. is only 50%
Create a Hand Hygiene
Compliant Culture
• Develop interpersonal infrastructures for peer
enforcement and practice
• Evaluate and improve the reliability of hand
hygiene on a continuing basis
• Empower patients to be their own healthcare
advocates
– It’s OK to ask if they “washed” their hands
Assessment Tools
To evaluate results of hand hygiene efforts,
compare:
• Baseline hand hygiene compliance rates and
perceptions among healthcare workers, with
• Baseline incidence/transmission MRSA rates for
the Qsource project unit
Consider distribution of a questionnaire for baseline
culture and knowledge assessment
Training/Education
• Onsite training based on the “My 5 Moments for
Hand Hygiene” approach, using situational skills
and expertise coaching (Train-the-Trainer)
• Training for observers using a “bundle” approach
with competency checkoffs in the unit
• Indications and procedures using teamwork and
transparency
Training/Education
• Protocols for hand rubbing and hand washing
• Assessment of the availability of an alcohol-based
hand rub at the point of patient care
• “Reminders” for healthcare workers regarding
hand hygiene
– Key tools to prompt healthcare workers
– Informing patients and visitors of the standard of care
Training/Education
– “Come clean” reminder
cards summarizing when to
perform hand hygiene
– Reminder signs using staff
and physician champions
• “Come Clean”
reminder cards
• “Champion” Posters
Observation Form
• Document collection of hand hygiene data
through observation during routine care
• Regularly monitor for sustained improvement and
to identify areas of opportunity requiring further
interventions
Promote a Climate of Safety
• Active participation at
both institutional and
individual levels
• Awareness of individual
and institutional
capacity to change and
improve hand hygiene
culture
• Partnership with
patients
Be Creative
Step Out of the Box
Provide Positive Reinforcement
… or a simple Thank You
Hand Hygiene Coordinator
Profile
• Professional
• Understanding of hand hygiene and infection
control issues
• Quality- and safety-oriented
• Well respected
• Accessible to frontline staff
• “Having the ear of” management staff
Hand Hygiene Coordinator
Tasks
• Propose an Action Plan incorporating:
– WHO guidelines
– CDC guidelines
– Current facility-level guidelines
• Discuss with senior-level managers
• Coordinate implementation at all stages
• Lead the training of trainers and observers
How Qsource Will Help
• Provide toolkit and training for the trainers and
observers in the project unit
• Prepare baseline evaluation data
• Disseminate results among key initiative players
• Evaluate MRSA/hand hygiene rates in the project
unit
• Determine how to present data and use the
results to further the project goals
Your Specific Actions
• Provide link for Qsource culture/knowledge assessment
• Distribute assessment materials and baseline data and
provide practical training at educational sessions
• Provide strategic support for performing hand hygiene and
lead by example
• Report hand hygiene observations and results monthly
• Conduct regular meetings of the team/committee to
monitor progress, overcome potential obstacles, and
adjust plans, if necessary
• Ensure regular, critical data feedback to frontline and
executive staff
• Enter MRSA LabID/infection surveillance events in
NHSN with conferred rights to Qsource
Questions?
Thank You!
Deborah Scott, RN
Quality Improvement/Infection Prevention Specialist
Phone: 800.528.2655 ext. 2601
eMail: dscott@qsource.org
This material was prepared by Qsource, the Medicare Quality Improvement Organization for Tennessee, under contract with the
Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. QSource-TN-PS2011-01