title: Using the Targeted Solutions Tool® to Improve Hand Hygiene Compliance Is Associated with Decreased Health Care-Associated Infections.
abstract: BACKGROUND
  In 2010 Memorial Hermann Health System (MHHS) implemented the Joint Commission Center for Transforming Healthcare's (the Center's) Web-based Targeted Solutions Tool ®(TST ®) for improving hand hygiene through-out its 12 hospitals after participating in the Center's first project on hand hygiene, pilot testing the TST, and achieving significant improvement for each pilot unit. Because hand hygiene is a key contributing factor in health care-associated infections (HAIs), this project was an important part of MHHS's strategy to eliminate HAIs.
  
  
  METHODS
  MHHS implemented the TST for hand hygiene in 150 inpatient units in 12 hospitals and conducted a system wide process improvement project from October 2010 through December 2014. The TST enabled MHHS to measure compliance rates, identify reasons for noncompliance, implement tested interventions provided by the TST, and sustain the improvements. Data on rates of ICU central line- associated bloodstream infections (CLABSIs) and ventilator- associated pneumonia (VAP) were also collected and analyzed.
  
  
  RESULTS
  Based on 31,600 observations (October 2010- May 2011), MHHS's system wide hand hygiene compliance baseline rate averaged 58.1%. Compliance averaged 84.4% during the "improve" phase (June 2011-November 2012), 94.7% in the first 13 months of the "control phase" (December 2012-December 2014) and 95.6% in the final 12 months (p < 0.0001 for all comparisons to baseline). Con comitantly, adult ICU CLABSI and VAP rates decreased by 49% (p = 0.024) and 45% (p = 0.045), respectively.
  
  
  CONCLUSIONS
  MHHS substantially improved hand hygiene compliance in its hospitals and sustained high levels of compliance for 25 months following implementation. Adult ICU CLABSI and VAP rates decreased in association with the hand hygiene compliance improvements.
authors.affiliation: Memorial Hermann Health System, Houston, USA.
authors.forename: M Michael
authors.initials: MM
authors.lastname: Shabot
authors.forename: Mark R
authors.initials: MR
authors.lastname: Chassin
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: France
authors.forename: Juan
authors.initials: J
authors.lastname: Inurria
authors.forename: Jan
authors.initials: J
authors.lastname: Kendrick
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Schmaltz
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D019982:Organizational Case Studies; D009937:Organizational Objectives; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D013781:Texas; D014481:United States