title: Utilizing improvement science methods to improve physician compliance with proper hand hygiene.
abstract: OBJECTIVE
  In 2009, The Joint Commission challenged hospitals to reduce the risk of health care-associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams.
  
  
  METHODS
  Strategies to improve hand hygiene were tested through multiple plan-do-study-act cycles, first by 1 general inpatient medical team and then spread to 4 additional teams. At the start of each rotation, residents completed an educational module and posttest about proper hand hygiene. Team compliance data were displayed daily in the resident conference room. Real-time identification and mitigation of failures by a hand-washing champion encouraged shared accountability. Organizational support ensured access to adequate hand hygiene supplies. The main outcome measure was percent compliance with acceptable hand hygiene, defined as use of an alcohol-based product or hand-washing with soap and turning off the faucet without using fingers or palm. Compliance was defined as acceptable hand hygiene before and after contact with the patient or care environment. Covert bedside observers recorded at least 8 observations of physicians' compliance per day.
  
  
  RESULTS
  Physician compliance with proper hand hygiene improved to >95% within 6 months and was sustained for 11 months.
  
  
  CONCLUSIONS
  Instituting a hand-washing champion for immediate identification and mitigation of failures was key in sustaining results. Improving physician compliance with proper hand hygiene is achievable and a first step in decreasing health care-associated infections.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. christine.white@cchmc.org
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
authors.forename: Angela M
authors.initials: AM
authors.lastname: Statile
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Conway
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schoettker
authors.forename: Lauren G
authors.initials: LG
authors.lastname: Solan
authors.forename: Ndidi I
authors.initials: NI
authors.lastname: Unaka
authors.forename: Navjyot
authors.initials: N
authors.lastname: Vidwan
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Warrick
authors.forename: Connie
authors.initials: C
authors.lastname: Yau
authors.forename: Beverly L
authors.initials: BL
authors.lastname: Connelly
mesh_terms: D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control / Q000379:methods*; D061214:Patient Safety / Q000592:standards*; D010820:Physicians