How one facility improved hand hygiene compliance 50%

The following content is sponsored by PDI.

According to the U.S. Centers for Disease Control and Prevention, it is estimated that one in every 25 hospitalized patients will contract a healthcare-associated infection. These infections can stem from resistant pathogens that can be spread through the hands of healthcare providers and patients as well as environmental surfaces.

Infection prevention and control experts recognize hand hygiene as the single most important intervention in decreasing the spread of infection in both healthcare and community settings. Surface disinfection is also critical for high-touch items — items used daily that become a reservoir for bacterial and viral growth — that are frequently used during and between patient visits.

Hand hygiene guidance and considerations

The 2009 World Health Guidelines for Hand Hygiene for Healthcare Settings indicates five instances for the nosocomial transmission of pathogens from one patient to another via the healthcare worker’s hands. They are as follows:

  • Microorganisms are present on the patient’s skin or are shed into the patient’s environment.
  • Microorganisms are transferred to the hands of the healthcare worker.
  • Microorganisms are able to survive on the hands of the healthcare worker.
  • The healthcare worker omits hand hygiene or inadequately performs it.

The healthcare worker’s contaminated hands come into direct contact with a patient or an item that will come into contact with a patient.

The goal of hand hygiene is to remove as much of the microorganisms on the hand as possible to avoid transmission. Soap and water is usually preferable, but CDC and WHO do endorse the use of alcohol-based hand rubs with alcohol concentration between 60 and 90 percent for healthcare worker hand hygiene.

Several factors must also be considered when selecting a hand hygiene agent in order to ensure compliance, efficacy and safety.

They are:

  • Cost of the agent
  • Ease of product use for healthcare workers
  • Potential for dermal irritation, skin reactions
  • Efficacy of the agent
  • Product availability and accessibility
  • Drying time after application
  • Staff support for the product selected

Improving Hand Hygiene at Kirklin Clinic

Janet Pate, JD, MHA, BSN, RN, director of infection prevention and employee health at Kirklin Clinic of University of Alabama Hospital in Birmingham, successfully improved hand and environmental hygiene at her facility through an improvement project that resulted in a 50 percent improvement in hand hygiene compliance.

In 2007, the Kirklin Clinic of UAB Hospital implemented a comprehensive hand and environmental hygiene program. The clinic’s goal was to improve overall hand and environmental hygiene compliance among all patients and staff.

Ms. Pate oversaw the program. Emphasizing the importance of never becoming “complacent,” Ms. Pate says the goal for the hygiene program was and is always “zero healthcare-associated infections and compliance with all evidence-based infection prevention recommendations.”

At Kirklin Clinic of UAB Hospital, Ms. Pate and her staff focused on reducing all five instances of the nosocomial transmission of pathogens, including the transmission of pathogens from a healthcare worker’s hands to a surface and onto the patient. To address this last type of transmission, the Clinic implemented the use of Super Sani-Cloth® germicidal disposable wipes, which were designated for disinfecting high-touch surfaces such as the exam table, the patient chair, countertops and door knobs between patient visits. For potential outbreaks, the Kirklin Clinic uses a 1:10 dilution of bleach solution (Sani-Cloth® Bleach).

Research has shown that in order to facilitate usage and reduce the amount of contamination within the immediate environment, it is vital to have infection prevention solutions that are readily available.

With this in mind, the clinic, in collaboration with PDI, conducted a full facility assessment to identify key locations for hand hygiene and surface cleaning stations. The clinic rolled out a full educational program encouraging hand washing and the correct use of the wipes for all facility employees. Ms. Pate lauds the staff for their “very positive” response to the implementation of the wipes.

“We are very fortunate that our healthcare providers and ancillary team members are fully committed to ensuring the safest patient care environment and positive patient experience. Our efforts are aimed at patient safety and patient satisfaction,” Ms. Pate says, regarding the increased compliance rate and the clinic-wide staff response.

The program also had a notable patient-centric approach. The clinic focused heavily on product availability not only for the healthcare provider team, but also the patients themselves. By making the alcohol-based hand wipes available in each exam room and in high traffic areas such as elevators, lobbies and patient entrances, hand hygiene compliance went from 41 percent to 90 percent.

Ms. Pate shares three points that helped her hand hygiene program be successful and will help others do the same. They are as follows:

  • Support. Have executive support and unit-based champions.
  • Accessibility. Point of care accessibility is key to success. Staff and patients must be able to access the products in order to be held accountable for using them.
  • Awareness. Partner carefully with industry partners to ensure maximum awareness of the latest infection prevention interventions and research recommendations.

As Ms. Pate’s experience shows, there are a few instrumental strategies for compliance and success in improving hand and environmental hygiene. As in the clinic, it is vital to place hand hygiene and surface disinfectants at the point of use. This ensures better accessibility and is key to compliance.

Furthermore, it is important to monitor practices routinely. Any non-compliant personnel should be counseled immediately. By creating unit-based local champions, as mentioned in the Comprehensive Unit-Based Safety Program developed by Johns Hopkins University, creating a culture of accountability throughout the organization is instrumental to the success in implementing a hand hygiene and surface disinfection program. The focus should always be on the prevention of the pathogen versus responding to transmission of infection. By engaging both the care delivery team and the patient, compliance increases and prevention is more successful.


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