title: A multifactorial action plan improves hand hygiene adherence and significantly reduces central line-associated bloodstream infections.
abstract: BACKGROUND
  Although hand hygiene (HH) is key to reducing health care-associated infections, it is well documented that health care worker (HCW) adherence to appropriate HH protocols is relatively low.
  
  
  METHODS
  This was a collaborative quality improvement project with multiple interventions conducted in a 570-bed academic hospital in Columbia, MO between April 2006 and September 2012. A multimodal action plan to improve HH adherence among all HCWs was developed, addressing 4 key areas: staff education, staff accountability, hand sanitizer product selection and accessibility, and organizational culture. HH adherence and central line-associated bloodstream infection (CLABSI) rates were monitored as outcome measures.
  
  
  RESULTS
  The overall HH adherence rate increased from 58% in April 2006 to 98% in September 2012. The adherence rates increased among all hospital units and among all HCW categories; in September 2012, HH adherence was 96% for physicians, 99% for nursing staff, and 99% for food services staff. CLABSI rates decreased over the same period, from 4.08 per 1000 device-days to 0.42 per 1000 device-days.
  
  
  CONCLUSIONS
  This multifactorial quality improvement project resulted in an institution-wide increase in HH adherence and a significant decrease in CLABSIs.
authors.affiliation: University of Missouri Health Care, Columbia, MO. Electronic address: johnsonls@health.missouri.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Johnson
authors.affiliation: University of Missouri Health Care, Columbia, MO.
authors.forename: Sarah
authors.initials: S
authors.lastname: Grueber
authors.affiliation: University of Missouri Health Care, Columbia, MO.
authors.forename: Cathy
authors.initials: C
authors.lastname: Schlotzhauer
authors.affiliation: University of Missouri Health Care, Columbia, MO.
authors.forename: Eileen
authors.initials: E
authors.lastname: Phillips
authors.affiliation: University of Missouri Health Care, Columbia, MO.
authors.forename: Paula
authors.initials: P
authors.lastname: Bullock
authors.affiliation: University of Missouri Health Care, Columbia, MO.
authors.forename: Jaime
authors.initials: J
authors.lastname: Basnett
authors.affiliation: University of Missouri Health Care, Columbia, MO.
authors.forename: Kristin
authors.initials: K
authors.lastname: Hahn-Cover
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D019983:Guideline Adherence / Q000592:standards*; D063373:Hand Hygiene; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008923:Missouri; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*
keywords: Alcohol-based hand rub; Health care-associated infections; Patient safety