title: Impact of 2 different levels of performance feedback on compliance with infection control process measures in 2 intensive care units.
abstract: BACKGROUND
  Performance monitoring and feedback of infection control process measures is an important tool for improving guideline adherence. Different feedback strategies may lead to distinctive outcomes.
  
  
  OBJECTIVE
  Our objective was to determine the relative impact of 2 different levels of feedback on compliance in an intensive care unit (ICU) setting.
  
  
  METHODS
  Proportion of head of bed (HOB) elevation, hand hygiene (HH) compliance, and proportion of femoral catheter (FC) to all central venous catheter-days were observed in a medical ICU and a surgical ICU. After a 3-month baseline observation phase (phase 1; P1), we provided quarterly feedback on these process measures and major health care-associated infections (HAIs) to unit leaders from July 2004 to June 2005 (P2). From July 2005 to June 2006 (P3), feedback parameters were also provided to unit leaders and to all staff via 48 x 72-inch color posters in ICU personnel-only areas. At the end of the study, a survey was performed to assess the influence of the posters and HH observations.
  
  
  RESULTS
  The analysis of IC process measures included 6948 HOB elevation observations, 1576 HH opportunities, and 16,591 catheter-days. In P2, the overall compliance with HOB elevation and the proportion of FC use significantly improved from 51% to 88% (P < .001) and 13% to 7% (P < .001), respectively. No significant difference in HH compliance was observed during this phase (40% vs 47%, respectively; P = .28). Comparing P3 with P2, HH compliance significantly improved from 47% to 71% (P < .001), and there was a slight improvement in HOB elevation rate from 88% to 93% (P < .001). There was no significant change in FC use in P3. There were 53 survey respondents. Sixty percent reported that the poster information changed their practices. Nearly all respondents (92%) knew that their HH behavior was being observed; however, 61% claimed that HH compliance was not influenced by observation.
  
  
  CONCLUSIONS
  Feedback of infection control process measures and major HAIs to unit leadership significantly improved compliance with HOB elevation rate and FC use but not HH. Multilevel feedback significantly improved HH compliance and delivered a satisfactory level of compliance with HOB and FC use in both ICUs during the study period.
authors.affiliation: Divisions of Infectious Diseases and Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA. sisaa@mahidol.ac.th
authors.forename: Susan
authors.initials: S
authors.lastname: Assanasen
authors.forename: Michael
authors.initials: M
authors.lastname: Edmond
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bearman
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004650:Employee Performance Appraisal; D005246:Feedback; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data*; D007362:Intensive Care Units; D010564:Personnel, Hospital; D011795:Surveys and Questionnaires