title: Quality-improvement initiative sustains improvement in pediatric health care worker hand hygiene.
abstract: OBJECTIVE
  To use quality-improvement (QI) methods to develop and test a multimodal intervention to improve hand-hygiene compliance among health care workers (HCWs) to >90%.
  
  
  METHODS
  We used a quasi-experimental staggered intervention that was conducted on 2 similar general pediatric units within a 475-bed tertiary children's hospital. Compliance was defined as acceptable hand hygiene both before and after contact with the patient or the patient's care environment. Measurement of HCW hand-hygiene compliance was performed by covert observations made during routine patient care. Twelve months of preintervention data were collected. QI methods were used to test and implement interventions sequentially in each unit. Interventions addressed leadership support, improving HCW knowledge, hand-hygiene supply availability, and HCW behavior.
  
  
  RESULTS
  Interventions began on unit A on November 10, 2008. Similar interventions were later tested on unit B starting March 23, 2009. By April 1, 2009, compliance increased on unit A (from 65% to 91%) and unit B (from 74% to 92%). Improvement on each unit occurred only after the interventions were introduced. Identifying HCWs who failed to perform hand hygiene and offering alcohol-based hand rub to them before patient contact resulted in the greatest improvement. Improvements were sustained on both units for 18 months.
  
  
  CONCLUSIONS
  Use of QI methods to implement a multimodal intervention resulted in sustained improvement in hand-hygiene compliance. Real-time individual performance feedback or other high-reliability human-factor interventions seem to be necessary to reach and sustain high levels of hand-hygiene compliance.
authors.affiliation: Infectious Diseases Section, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas 72202-3500, USA. wlinam@uams.edu
authors.forename: W Matthew
authors.initials: WM
authors.lastname: Linam
authors.forename: Peter A
authors.initials: PA
authors.lastname: Margolis
authors.forename: Harry
authors.initials: H
authors.lastname: Atherton
authors.forename: Beverly L
authors.initials: BL
authors.lastname: Connelly
mesh_terms: D000488:Allied Health Personnel; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007857:Leadership; D010372:Pediatrics; D058996:Quality Improvement