title: Improving hand hygiene compliance in health care workers: Strategies and impact on patient outcomes.
abstract: BACKGROUND
  We described a systematic process for improving hand hygiene (HH) compliance in health care providers and assessed the impact of HH on patient outcomes.
  
  
  METHODS
  This retrospective cohort study was conducted between July 2008 and September 2011 in a children's hospital. We employed failure mode effectiveness analysis to identify barriers for complying with HH requirements and instituted improvement measures. We conducted a subanalysis using methicillin-resistant Staphylococcus aureus (MRSA) acquisition data and HH compliance data collected in the neonatal intensive care unit (NICU) to demonstrate the impact of HH on patient outcomes.
  
  
  RESULTS
  The overall HH compliance rate increased from 50.3% preintervention (July 2008-September 2008) to 84.0% postintervention (January 2009-September 2011) (relative risk [RR], 1.7; 95% confidence interval [CI]: 1.6-1.9). Compliance among physicians and nurses increased from 48.6% to 87.0% (RR, 1.4; 95% CI: 1.3-1.6) and from 46.5% to 77.9% (RR, 1.3; 95% CI: 1.2-1.4), respectively. Sustaining HH at 80% or higher was associated with a 48% further reduction of MRSA acquisition (incident rate ratio, -0.52; 95% CI: -0.31 to -0.90) in a unit that had comprehensive MRSA prevention measures. This reduction represents the prevention of 1.3 MRSA acquisitions per month, resulting in a saving of 11.6 NICU-days and $66,397 hospital charges.
  
  
  CONCLUSIONS
  This study demonstrated the utility of failure mode effectiveness analysis to improve staff HH and suggested HH as a potential cost-effective means for preventing MRSA in hospitals.
authors: Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Division of Infectious Disease, Children's National Medical Center, Washington, DC. Electronic address: xsong@cnmc.org.
authors: Xiaoyan
authors: X
authors: Song
authors: David C
authors: DC
authors: Stockwell
authors: Tara
authors: T
authors: Floyd
authors: Billie L
authors: BL
authors: Short
authors: Nalini
authors: N
authors: Singh
mesh_terms: D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D015331:Cohort Studies; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods*; D006282:Health Personnel; D006776:Hospitals, Pediatric; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D015995:Prevalence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology
keywords: Cost; Hand washing; MRSA