Development Of a Public-Private Sustaining Model For Continuous Hand Hygiene Observations In All Maine Acute Care Hospitals, 2012

BACKGROUND:  The most effective method to reduce healthcare associated infections is hand hygiene. The World Health Organization considers direct observation of hand hygiene practices as the “gold standard” to measure adherence rates. The Maine Center for Disease Control and Prevention (Maine CDC) performed two day-long site visits to observe hand hygiene practices in all Maine acute care hospitals in 2011. In 2012, Maine CDC identified a need to create a self-sustaining hand hygiene observation process in Maine hospitals to provide continuous feedback to hospital administrations.

METHODS:  Standardized definitions of hand hygiene compliance and a data collection tool were developed by Maine’s hospital infection prevention advisory group. Maine CDC collaborated with hospital infection prevention partners to develop a self-sustaining model for ongoing external hand hygiene observations. Infection preventionists agreed to conduct hand hygiene observations at a neighboring facility biannually. Maine CDC divided all 36 acute care hospitals into pairs so infection preventionists would observe at a facility within one hour away. They observed a medical-surgical unit, an intensive care unit, and the emergency department; they could observe facility-wide if census was low. Infection preventionists were encouraged to complete six hours of observations in lieu of one monthly advisory group meeting. Maine CDC collected and analyzed the data and produced summary reports distributed to hospital chief executive officers. Hand hygiene compliance was calculated as the number of instances where hand hygiene was observed divided by the total number of observations.

RESULTS:  Infection preventionists have conducted two external observation site visits in 2012. The model is in place so that every six months the monthly advisory group meeting is cancelled so infection preventionists may conduct hand hygiene observations with the allotted time. Anecdotally, infection preventionists perceive external observations to be more accurate than facilities’ internal observations done by hospital staff, especially now that they are routinely conducted by the infection preventionists.

CONCLUSIONS:  This model allows all hospitals in Maine to receive externally observed hand hygiene compliance data every six months. There continues to be variation in hand hygiene compliance between facilities, within facilities, and by different health disciplines. External hand hygiene observations have been used to support policy changes among hospital personnel, obtain buy-in from hospital administration, and promote infection prevention efforts. Self-sustaining models of external observations provides the necessary ongoing feedback to keep hand hygiene as a top hospital priority and ultimately reduce healthcare associated infections.