title: Hospital hand hygiene compliance improves with increased monitoring and immediate feedback.
abstract: BACKGROUND
  Health care-associated infections are serious complications impacting 2 million patients and accounting for approximately 100,000 deaths per year. In the present study, we evaluated the effectiveness of a new hand hygiene monitoring program (HHMP) and measured the sustainability of this effectiveness over a 1-year period.
  
  
  METHODS
  The HHMP consisted of 4 key components: extensive education, conspicuous and visible monitors, immediate feedback concerning compliance to health care workers, and real-time data dissemination to leadership. The HHMP was implemented in 2 hospital care units. Two different, but similar, departments served as controls, and hand hygiene compliance was monitored via the "secret shopper" technique. All 4 departments were followed for 12 months.
  
  
  RESULTS
  Both experimental departments showed statistically significant increases in hand hygiene compliance. Experimental department 1 increased compliance from 49% to an average of 90%, and experimental department 2 increased compliance from 60% to an average of 96%. Both experimental departments were able to sustain these results for at least 6 months. Compliance rates were significantly higher in the experimental departments compared with the control departments. No significant changes were seen in the control departments.
  
  
  CONCLUSIONS
  These finding suggest that continuous monitoring by salient observers and immediate feedback are critical to the success of hand hygiene programs.
authors.affiliation: Quality Resources-Infection Prevention, Mercy Hospital-Springfield, Springfield, MO. Electronic address: judith.walker@mercy.net.
authors.forename: Judy L
authors.initials: JL
authors.lastname: Walker
authors.affiliation: Quality Resources-Infection Prevention, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: William W
authors.initials: WW
authors.lastname: Sistrunk
authors.affiliation: Quality Resources-Infection Prevention, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Higginbotham
authors.affiliation: Quality Resources-Infection Prevention, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: Kristi
authors.initials: K
authors.lastname: Burks
authors.affiliation: Quality Resources-Infection Prevention, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: Linda
authors.initials: L
authors.lastname: Halford
authors.affiliation: Quality Resources-Infection Prevention, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: Linda
authors.initials: L
authors.lastname: Goddard
authors.affiliation: Department of Statistics, University of Missouri, Columbia, MO.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Thombs
authors.affiliation: Division of Trauma and Burn Research, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: Cindy
authors.initials: C
authors.lastname: Austin
authors.affiliation: Division of Trauma and Burn Research, Mercy Hospital-Springfield, Springfield, MO.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Finley
mesh_terms: D062665:Epidemiological Monitoring; D005246:Feedback; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods*; D063373:Hand Hygiene; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*
keywords: Hand hygiene; Hand hygiene monitoring program; Hospital-associated infection; Intervention; Monitoring program