Infection prevention promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel.
BACKGROUND
Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.


OBJECTIVE
To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.


METHODS
Time series design.


METHODS
Our study was conducted at a tertiary care academic center.


METHODS
Hospital healthcare personnel.


METHODS
We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by "undercover" observers.


RESULTS
Overall hand hygiene compliance increased by 2-fold after full program implementation (P < .001), and this increase was sustained over a 20-month follow-up period (P < .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53-4.23; P < .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P < .001), from 38% to 62% among medical providers (P < .001), and from 27% to 75% among environmental services staff (P < .001).


CONCLUSIONS
Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.
Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, Maryland, USA. habouma1@jhmi.edu
Hanan
H
Aboumatar
Polly
P
Ristaino
Richard O
RO
Davis
Carol B
CB
Thompson
Lisa
L
Maragakis
Sara
S
Cosgrove
Beryl
B
Rosenstein
Trish M
TM
Perl
D015142:Baltimore; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D008505:Medical Staff, Hospital / Q000592:standards*; D008962:Models, Theoretical; D009741:Nursing Staff, Hospital / Q000592:standards*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012189:Retrospective Studies