1. Reaching the Gold Standard in Hand Hygiene
Charlene Chadwick RN BSN
Introduction: This poster presentation will illustrate how nursing leadership could accomplish increasing and maintaining hand hygiene compliance in all areas of healthcare
and use this as an element in the role of preventing healthcare associated infections.
Literature Review: CINAHL
Websites: Joint Commission, Association for Professionals in Infection
Control and Epidemiology, Center for Disease Control, World Health
Organization
Inclusion: 2010-2015
Terms Used: “Hand Hygiene” and “Compliance” and “Monitoring”
Results
•Hand Hygiene compliance remains a challenge.
•Larger organizations were able to implement costly electronic
monitoring and still had difficulties maintaining compliance.
•Smaller facilities used direct observation and self-reporting and still had
difficulties maintaining compliance.
•Education is a priority using the Joint Commission and World Health
Organization guidelines. Needs to be continued annually.
•Hawthorne effect: a person performs better knowing someone is
observing them (Hagel et al., 2015).
Proposed
Intervention
Proposed
Intervention
1. Provide education using recommend guidelines
2. Recruit RN’s as observers, they are knowledgeable regarding consequences of healthcare associated infections.
3. Direct observation limited to 15 minutes.
4. Perform baseline assessment for 4 weeks reporting weekly to Infection Control who will tabulate results and
report to nursing leaders.
5. Continue to do direct observation and provide immediate real time education to those who are negligent
6. Continue education frequently in all forms to reach all levels of education.
Using the iScrub (The University of Iowa, 2009) application for documentation, results can
be immediately emailed to Infection Control. Results can be tabulated and charts used as
visual aids for information to all stakeholders illustrating compliance or need for intervention.
Metrics & Outcomes
Hand Hygiene monitoring
illustrates a low percentage
prior to education in the 1st
quarter & again when there
hasn’t been any recent
education in 4th
quarter.
Research indicates that hand hygiene monitoring and compliance can be met. The best compliance program must begin with education.
Using the recommended guidelines as a foundation for education results provided will be evidenced-based. Education should begin with
the Infection Control preventionists dedicated to hand hygiene compliance with a dedicated budget for hand hygiene education. Literature
review recommends direct observation being the Gold Standard for hand hygiene (Huis et al., ,2013) and (Yin et al., 2014).
Using the iScrub application allows for immediate feedback to Infection Control who in turn communicates to all stakeholders.
Reference:
•Hagel, S., Reischke, J., Kesselmeier, M., Math, D., Winning, J., Gastmeier, P., ..Pletz, M. (2015, August).
Quantifying the Hawthorne Effect in hand hygiene compliance through comparing direct observation with
automated hand hygiene monitoring. Infection Control and Hospital Epidemiology, 36(8), 957-62.
http://dx.doi.org/10.1017/ice.2015.93
•Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & Van Achterberg, T. (2013). Impact of a team
and leaders-directed strategy to improve nurses adherence to hand hygiene guidelines: A cluster randomized trial.
International Journal of Nursing Studies, 50, 464-474. http://dx.doi.org/10.1016/j.ijnurstu.2012.08.004
•The University of Iowa. (2009). https://compepi.cs.uiowa.edu/index.php/Research/IScrub
•Yin, J., Reisinger, H., Weg, M., Schweizer, M., Jesson, A., Morgan, D., ... Perencevich, E. (2014, September).
Establishing evidence-based criteria for directly observed hand hygiene compliance monitoring programs: A
prospective, multicenter cohort study. Infection Control & Hospital Epidemiology, 35(9), 1163-1168.
http://dx.doi.org/10.1086/677629