Dissemination and sustainability of a hospital-wide hand hygiene program emphasizing positive reinforcement.
OBJECTIVE
To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors.


METHODS
Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006).


METHODS
A 450-bed teaching tertiary-care hospital.


METHODS
An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.


RESULTS
A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P <.001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%-84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%-81% of 4,990 opportunities during year 6 of the program.


CONCLUSIONS
This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.
Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA. jeanmarie.mayer@hsc.utah.edu
Jeanmarie
J
Mayer
Barbara
B
Mooney
Adi
A
Gundlapalli
Stephan
S
Harbarth
Gregory J
GJ
Stoddard
Michael A
MA
Rubin
Louise
L
Eutropius
Britt
B
Brinton
Matthew H
MH
Samore
D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control; D004059:Diffusion of Innovation; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods; D019538:Health Care Surveys; D006801:Humans; D006920:Hygiene; D010564:Personnel, Hospital; D012054:Reinforcement, Psychology; D040242:Risk Reduction Behavior