A new approach to improving hand hygiene practice in an inner city acute hospital in Australia
Giulietta Pontivivo A H , Ketty Rivas B C , Julie Gallard D , Nickolas Yu E and Lin Perry F GA Centre for Hospital Epidemiology and Staff Services, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia.
B Clinical Practice Improvement Unit, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia.
C Sydney Eye Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia.
D Infection Prevention and Control, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
E Nurse Education & Research Unit, Prince of Wales Hospital, Randwick, NSW 2031, Australia.
F Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Eton Road, Lindfield, NSW 2070, Australia.
G Prince of Wales Hospital, Randwick, NSW 2031, Australia.
H Corresponding author. Email: giulietta.pontivivo@sesiahs.health.nsw.gov.au
Healthcare Infection 17(2) 57-63 https://doi.org/10.1071/HI12007
Submitted: 15 February 2012 Accepted: 19 April 2012 Published: 22 May 2012
Abstract
Background: Healthcare-associated infections occur in 5–15% of hospitalised patients, with 30–50% preventable. Hand hygiene is a basic and essential but poorly conducted method to limit infection in hospitals. This practice development approach to implementing the ‘5 Moments for Hand Hygiene’ national initiative aimed to increase compliance with the recommended hand hygiene practices, anticipating this outcome would be reflected in lower rates of healthcare-associated infections.
Methods: Multiple methods were employed during October 2009–October 2010 within a multi-disciplinary initiative, although nurses were mainly recruited. Three medical wards, four surgical wards and the Intensive Care Unit were targeted. Project activities were informed by principles of practice development, solution-focussed coaching and models of behaviour change. Activities included active learning sessions, coaching, audit and feedback, competitions, creativity and fun. Outcomes were observations of hand hygiene compliance and routinely collected rates of Staphylococcus aureus bacteraemia.
Results: Overall hand hygiene audits showed statistically significant improvement in compliance, from 62 to 75% in quarterly audits. Compliance rates among nurses and medical staff increased significantly from 70 to 80% and from 43 to 63%, respectively, while changes for allied health practitioners, from 61 to 65% compliance, did not achieve significance. Recorded rates of Staphylococcus aureus bacteraemia reduced from between 0.6 and 2.55 infections per 10 000 occupied bed days pre-project to between 0 and 0.65 infections per 10 000 occupied bed days during the project period.
Conclusions: Multiple methods using a practice development framework can be successful in effecting changes in hand hygiene behaviour among all health care workers. Study methods took planning and commitment but were highly rewarding, particularly considering the magnitude of the issue for patient and clinician safety.
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