title: Increasing hand hygiene compliance by use of a novel hand held device at a university hospital - biomed 2013.
abstract: OBJECTIVE
  Hand hygiene (HH) is the single most effective modality to prevent the spread of infection in healthcare. HH is also one of the most difficult quality measures to monitor. In a 722 bed tertiary referral teaching hospital, collection of accurate and timely HH compliance data on 25 inpatient units was problematic. We needed a process that avoided confrontation and keep secret the identity of HH surveyors to avoid compromise of professional work relationships. Our solution was to employ a unique handheld device.
  
  
  METHODS
  iScrub®, a hand-held application developed by The University of Iowa, was used to record compliance with HH. Dates of intervention were January 1st  December 31st, 2011. HH observations were collected by trained nursing volunteers and displayed on a central intranet based database using SharePoint software®. Data was then included in quality scorecards, and in the Infection Prevention (IP) monthly report. Episodes of non-compliance generated e-mail notifications with escalating consequences that might end with termination of employment. Multi-drug resistant organisms (MDROs) surveillance was performed by the infection prevention department (IPD). HH and MDROs monthly data analysis was published on SharePoint® for stakeholders review.
  
  
  RESULTS
  During the intervention we collected 26,657 observations. Average HH compliance was 95%,( average physicians compliance was 88%, and average nurses compliance was 98%). Non-compliance occurred at a similar frequency both before and after patient contact. Alcohol hand rub was the most frequently used method to perform HH. Physicians demonstrated the lowest compliance rates among healthcare workers. Time and date of observations had no effect on compliance.
  
  
  CONCLUSIONS
  Shielding the identity of HH observers eliminated confrontation, and probably increased the accuracy of collected data. Applying strict consequences for non-compliance with HH aided in increasing compliance among staff and physicians. Publishing HH data analysis aided in increasing the compliance with HH. Data analysis identified issues related to the use of the current application and led to the creation of a new HH application.
authors.affiliation: University of Mississippi Medical Center.
authors.forename: Elham
authors.initials: E
authors.lastname: Ghonim
authors.forename: Rathel
authors.initials: R
authors.lastname: Nolan
authors.forename: Hamed
authors.initials: H
authors.lastname: Benghuzzi