Improve hand hygiene by targeting specific noncompliance issues

A targeted approach to hand hygiene improvement — focusing improvement efforts on specific issues of noncompliance — can be more effective than a "one-size-fits-all" strategy, according to an article in the January issue of The Joint Commission Journal on Quality and Patient Safety.

The Joint Commission Center for Transforming Healthcare started its first patient safety project on hand hygiene in 2008, putting together teams in eight hospitals. Using lean, Six Sigma and change management methods, the teams measured noncompliance rates and found specific causes of hand hygiene failures.

At the baseline across the eight hospitals, hand hygiene compliance rates averaged 47.5 percent. Reasons for noncompliance varied hospital to hospital but could be separated into 24 groups of causes, including inconvenient placement of hand rub dispenser or sink, broken dispensers, lack of accountability or a worker's hands being full.

So, each hospital team developed specific interventions to improve hand hygiene compliance based on the hospital's specific noncompliance issues. After the projects and improvements were implemented, there was a 70.5 percent increase in hand hygiene compliance across the eight hospitals (improving compliance from 47.5 percent to 81 percent).

When hospitals customize hand hygiene improvement efforts to the issues at the individual hospital, it may be "more effective, efficient and sustainable than 'one-size-fits-all' strategies," the study's authors concluded.

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