title: Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement.
  
  
  OBJECTIVE
  To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO.
  
  
  METHODS
  Six Sigma Project with pre-post design.
  
  
  METHODS
  Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals.
  
  
  METHODS
  Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire.
  
  
  RESULTS
  Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products.
  
  
  CONCLUSIONS
  The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.
authors.affiliation: Department of Veterans Affairs, Veterans Health Administration, National Center for Patient Safety, Washington, DC 20420, USA. noel.eldridge@va.gov
authors.forename: Noel E
authors.initials: NE
authors.lastname: Eldridge
authors.forename: Susan S
authors.initials: SS
authors.lastname: Woods
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bonello
authors.forename: Kay
authors.initials: K
authors.lastname: Clutter
authors.forename: Leann
authors.initials: L
authors.lastname: Ellingson
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Harris
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Livingston
authors.forename: James P
authors.initials: JP
authors.lastname: Bagian
authors.forename: Linda H
authors.initials: LH
authors.lastname: Danko
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Dunn
authors.forename: Renee L
authors.initials: RL
authors.lastname: Parlier
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pederson
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Reichling
authors.forename: Gary A
authors.initials: GA
authors.lastname: Roselle
authors.forename: Steven M
authors.initials: SM
authors.lastname: Wright
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D002983:Clinical Competence; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000592:standards*; D006284:Health Plan Implementation; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D010564:Personnel, Hospital / Q000193:education; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D017749:Total Quality Management / Q000379:methods*; D014481:United States