Hand hygiene behavior change: a review and pilot study of an automated hand hygiene reminder system implementation in a public hospital.

OBJECTIVE

To review and study implementation of an automated hand hygiene reminder system (AHHRS).

DESIGN

Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months.

SETTING

Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City.

PARTICIPANTS

There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred.

INTERVENTION

We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot.

RESULTS

Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, < .01) and MICU (91.21% vs 98.65%, < .01). HHA significantly improved from 86.47% to 89.68% in MSU ( < .001) and 85.93% to 91.24% in the MICU ( < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU ( < .05).

CONCLUSIONS

We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.