Albert Ben D, Petti Chonel, Caraglia Adrianna, Geller Margaret, Horak Robin, Barrett Megan, Hastings Ryan, O'Brien Mary, Ormsby Jennifer, Sandora Thomas J, Kleinman Monica E, Priebe Gregory P, Mehta Nilesh M
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Mass.
Department of Anesthesia Critical Care Medicine, Children's Hospital of Los Angeles, CA and.
Pediatr Qual Saf. 2019 Nov 6;4(6):e227. doi: 10.1097/pq9.0000000000000227. eCollection 2019 Nov-Dec.
Suboptimal hand hygiene (HH) remains a significant modifiable cause of healthcare-associated infections in the intensive care unit. We report a single-center, quality improvement project aimed at improving adherence to optimal HH among physicians, nurse practitioners, and nursing staff, and to sustain any improvement over time.
A key driver diagram was developed to identify 5 primary drivers of change: leadership support, education initiatives, patient-family engagement, increased audit frequency, and individual feedback to promote accountability. We examined HH compliance over 3 years in 3 phases (pre-intervention, intervention, and post-intervention). The intervention period involved a multimodal approach designed to influence unit culture as well as individual HH practice. HH screens were installed outside the patient rooms to provide just-in-time reminders and display of regularly updated HH adherence data for provider groups.
We recorded 6,563 HH opportunities, providers included nurses (66%), attendings (12%), fellow/resident (16%), and nurse practitioners (NP) (6%). All clinical groups demonstrated HH compliance >90% during the post-intervention period. The improvements in practice were sustained for a year after the intervention.
Our report highlights modifiable factors that impact HH and may inform quality improvement interventions aimed at improving HH compliance at other centers.
手部卫生欠佳仍是重症监护病房医疗相关感染的一个重要可改变原因。我们报告了一项单中心质量改进项目，旨在提高医生、执业护士和护理人员对手部卫生最佳做法的依从性，并随着时间推移维持任何改进。
绘制关键驱动因素图以确定5个主要变革驱动因素：领导支持、教育举措、患者家属参与、增加审核频率以及促进问责制的个人反馈。我们分3个阶段（干预前、干预和干预后）对3年期间的手部卫生合规情况进行了检查。干预期采用多模式方法，旨在影响科室文化以及个人手部卫生做法。在病房外安装了手部卫生检查设备，以提供即时提醒，并展示为医疗人员定期更新的手部卫生依从性数据。
我们记录了6563次手部卫生机会，医疗人员包括护士（66%）、主治医师（12%）、住院医师（16%）和执业护士（6%）。在干预后期间，所有临床组的手部卫生合规率均>90%。干预后，实践中的改进持续了一年。
我们的报告突出了影响手部卫生的可改变因素，并可能为旨在提高其他中心手部卫生合规性的质量改进干预措施提供参考。
