title: Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance.
abstract: The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital.
  
  
  
  This study was a time-series, quality-improvement project. Interventions were tested through multiple plan-do-study-act cycles on 2 pediatric inpatient units. HH compliance audits of HCWs on these units were performed randomly each week by the hospital infection prevention program. Control charts of percentages of HCW HH compliance were constructed with 3-σ (data within 3 SDs from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Charts were annotated with interventions including (1) increasing awareness, (2) providing timely feedback, (3) empowering patients and families to participate in mitigation, (4) providing focused education, and (5) developing interdisciplinary HH champions.
  
  
  
  HH compliance rates improved from an average of 87% (LOR 1) to ≥95% (LOR 2) within 9 months, and this improvement has been sustained for >2 years on both pediatric inpatient units.
  
  
  
  Significant and sustained gains in HH compliance rates of ≥95% (LOR 2) can be achieved by applying high-reliability human-factor interventions.
authors.affiliation: Division of Hospital and Emergency Medicine, Department of Pediatrics, and heather.mclean@duke.edu.
authors.forename: Heather S
authors.initials: HS
authors.lastname: McLean
authors.affiliation: Duke Program for Infection Prevention, Duke University Medical Center, Durham, North Carolina.
authors.forename: Charlene
authors.initials: C
authors.lastname: Carriker
authors.affiliation: Division of Hospital and Emergency Medicine, Department of Pediatrics, and.
authors.forename: William Clay
authors.initials: WC
authors.lastname: Bordley
mesh_terms: D005246:Feedback; D063373:Hand Hygiene; D006282:Health Personnel; D006776:Hospitals, Pediatric; D006801:Humans; D017053:Infection Control; D007857:Leadership; D009657:North Carolina; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*