title: Practically speaking: rethinking hand hygiene improvement programs in health care settings.
abstract: BACKGROUND
  Hand hygiene is widely recognized as the single most effective means of reducing health care-associated infections. Implementing a credible hand hygiene program and maintaining high compliance among staff is both expected and required of hospitals. However, beyond general guidelines, few resources are available for establishing an institution-wide hand hygiene program that is both successful and sustainable over the long term.
  
  
  METHODS
  Beginning in 2008, we completely overhauled the approach to hand hygiene at our institution. We created small teams consisting of a representative from Quality Assessment, an Infection Prevention Practitioner, and staff from a particular unit. Teams began by discussing the current barriers to hand hygiene success. They then set their own goals for hand hygiene compliance. Staff learned the World Health Organization (WHO) hand hygiene guidelines, which recently had been adopted as part of hospital infection prevention policy. Using the WHO guidelines, teams diagrammed detailed workflows for several of their most common patient care tasks. Wherever hand hygiene was indicated, the workflow was marked with a number corresponding to one or more of the WHO's "5 moments for hand hygiene." At the end of the 12-week period, staff members were trained to observe each other and began officially collecting and submitting data to Infection Prevention.
  
  
  RESULTS
  Between 2006 and 2008, our average institutional hand hygiene compliance held steady at 60%-70%. After the new program was launched in 2008, compliance reached 97% and has been maintained at this level ever since. In addition to the 19 areas of the hospital that were observed previously, 15 ambulatory facilities and 5 regional sites are now included in the data.
  
  
  CONCLUSIONS
  This article describes a novel approach to measuring, monitoring, and ultimately increasing hand hygiene compliance at our hospital. Our objective is to provide concrete, practical strategies for other institutions faced with the challenge of building or revamping their own hand hygiene programs.
authors.affiliation: Department of Infection Control, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. sonc@mskcc.org
authors.forename: Crystal
authors.initials: C
authors.lastname: Son
authors.forename: Tina
authors.initials: T
authors.lastname: Chuck
authors.forename: Teresa
authors.initials: T
authors.lastname: Childers
authors.forename: Shauna
authors.initials: S
authors.lastname: Usiak
authors.forename: Mary
authors.initials: M
authors.lastname: Dowling
authors.forename: Corinna
authors.initials: C
authors.lastname: Andiel
authors.forename: Regan
authors.initials: R
authors.lastname: Backer
authors.forename: Janet
authors.initials: J
authors.lastname: Eagan
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
mesh_terms: D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards*; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration*