Safety stand-down: How borrowing a military practice boosted this hospital's hand hygiene compliance to 94%

Nationwide Children's Hospital in Columbus, Ohio, was struggling with low hand hygiene compliance rates until it took a page out of the military's book and implemented a safety stand-down, ceasing nonessential hospital activities on all units to discuss action plans to improve hand hygiene.

The hospital detailed its story in the Journal of Patient Safety.

The issue dated back to 2010 when the hospital saw a spike in healthcare-associated infections, which spurred a renewed focus on hand hygiene. Covert observation found the hospital's compliance rate was roughly 65 percent.

After improving healthcare workers' access to hand sanitizer, the hospital hosted a hand hygiene-focused leadership safety summit, attended by all physician section/department chiefs, nurse managers and ancillary department directors. There, executives discussed the importance of hand hygiene and helped leaders develop an action plan for their unit to improve compliance.

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The summit also prepared leaders for the upcoming safety stand-down — a term borrowed from the military in which action ceases to allow senior leaders to talk to front-line workers to discuss safety issues. At the hospital, this meant every department and medical staff section stopped nonessential work to discuss how to improve hand hygiene on that unit.

"The attention and 'big splash' associated with stopping all nonessential clinical activity captured the hospital staff's attention and made it clear that this was important to everyone," according to the study.

Other hospitalwide elements of the improvement plan included:

  • Department or section heads whose sections were less than 90 percent compliant would have to meet with the CNO or CMO to discuss performance.
  • Any hospital personnel who was found to be noncompliant with hand hygiene regulations would need to meet face-to-face with the CNO or CMO on first and second offence. On third offence, a note would go in their personnel file.

After the safety stand-down, hand hygiene compliance rose from less than 60 percent to 94 percent, a statistically significant increase. And, with just two exceptions, overall hand hygiene compliance has been above 90 percent for roughly three and a half years, according to the study.

"This program can be easily implemented, costs little, and is relatively nonpunitive," the study concludes. "We suggest that other organizations still struggling to achieve high levels of hand hygiene compliance can use this relatively simple technique to improve their results."

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