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Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90%.

Reich JA, Goodstein ME, Callahan SE, Callahan KM, Crossley LW, Doron SI, Snydman DR, Nasraway SA - Crit Care (2015)

Bottom Line: Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria.In turn, this allowed for specific comparative monthly feedback to individual chiefs of service.Over the next 2 years after the study ended, these gains were sustained, suggesting an enduring culture change in physician behavior.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA. jreich@tuftsmedicalcenter.org.

ABSTRACT

Introduction: Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria. Despite mandatory education and reminders, compliance by physicians in our hospital remained stubbornly low. Our objective was to study whether surveillance by our unit coordinator (secretary) paired with regular feedback to chiefs of service would increase physician hand hygiene compliance in the ICU.

Method: The ICU unit coordinator was trained to observe and measure hand hygiene compliance. Data were collected on hand hygiene compliance at room entry and exit for 9 months. Percentage compliance for each medical and surgical subspecialty was reported to chiefs of service at the end of each month. Comparative rankings by service were widely distributed throughout the physician organization and the medical center.

Results: The hand hygiene compliance rate among physicians increased from 65.1% to 91.6% during the study period (p < 0.0001). More importantly in the succeeding 24 months after study completion, physician hand hygiene compliance remained >90% in every month.

Conclusions: Physician hand hygiene compliance increased as a consequence of the surveillance conducted by a full-time ICU team member, leading to a highly significant increase in the number of observations. In turn, this allowed for specific comparative monthly feedback to individual chiefs of service. Over the next 2 years after the study ended, these gains were sustained, suggesting an enduring culture change in physician behavior.

No MeSH data available.


Hand hygiene compliance trend in intervention group and post intervention group. Physicians’ rate of change (slope) was 3.1 % per month (p <0.001 95 % confidence interval (CI) 1.65–4.60) during the time when feedback was provided with report cards. Sustained compliance rate greater than 90 % is shown in the 24-month post study period
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Fig1: Hand hygiene compliance trend in intervention group and post intervention group. Physicians’ rate of change (slope) was 3.1 % per month (p <0.001 95 % confidence interval (CI) 1.65–4.60) during the time when feedback was provided with report cards. Sustained compliance rate greater than 90 % is shown in the 24-month post study period

Mentions: An overall hand hygiene compliance rate of 83.3 % was observed during the 9-month study period. Physicians increased their compliance rate from 65.1 % in the first month to 91.2 % in the last month. The slope of the regression curve represents the average rate of change for physicians of 3.1 % per month (p <0.0001) with 95 % confidence interval 1.65–4.60 %. The SICU team, trauma surgery service, and neurosurgery services combined to have more than 60 % of the total physician observations. Physicians met the institutional target goal rate of greater than 90 % in each of the final 3 months of the study and in each month of the ensuing 24-month post study period when no feedback was given to chiefs of service (Fig. 1). Examples of monthly feedback provided to chiefs of service are shown for study months 1 and 9 in Fig. 2.Fig. 1


Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90%.

Reich JA, Goodstein ME, Callahan SE, Callahan KM, Crossley LW, Doron SI, Snydman DR, Nasraway SA - Crit Care (2015)

Hand hygiene compliance trend in intervention group and post intervention group. Physicians’ rate of change (slope) was 3.1 % per month (p <0.001 95 % confidence interval (CI) 1.65–4.60) during the time when feedback was provided with report cards. Sustained compliance rate greater than 90 % is shown in the 24-month post study period
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536705&req=5

Fig1: Hand hygiene compliance trend in intervention group and post intervention group. Physicians’ rate of change (slope) was 3.1 % per month (p <0.001 95 % confidence interval (CI) 1.65–4.60) during the time when feedback was provided with report cards. Sustained compliance rate greater than 90 % is shown in the 24-month post study period
Mentions: An overall hand hygiene compliance rate of 83.3 % was observed during the 9-month study period. Physicians increased their compliance rate from 65.1 % in the first month to 91.2 % in the last month. The slope of the regression curve represents the average rate of change for physicians of 3.1 % per month (p <0.0001) with 95 % confidence interval 1.65–4.60 %. The SICU team, trauma surgery service, and neurosurgery services combined to have more than 60 % of the total physician observations. Physicians met the institutional target goal rate of greater than 90 % in each of the final 3 months of the study and in each month of the ensuing 24-month post study period when no feedback was given to chiefs of service (Fig. 1). Examples of monthly feedback provided to chiefs of service are shown for study months 1 and 9 in Fig. 2.Fig. 1

Bottom Line: Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria.In turn, this allowed for specific comparative monthly feedback to individual chiefs of service.Over the next 2 years after the study ended, these gains were sustained, suggesting an enduring culture change in physician behavior.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA. jreich@tuftsmedicalcenter.org.

ABSTRACT

Introduction: Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria. Despite mandatory education and reminders, compliance by physicians in our hospital remained stubbornly low. Our objective was to study whether surveillance by our unit coordinator (secretary) paired with regular feedback to chiefs of service would increase physician hand hygiene compliance in the ICU.

Method: The ICU unit coordinator was trained to observe and measure hand hygiene compliance. Data were collected on hand hygiene compliance at room entry and exit for 9 months. Percentage compliance for each medical and surgical subspecialty was reported to chiefs of service at the end of each month. Comparative rankings by service were widely distributed throughout the physician organization and the medical center.

Results: The hand hygiene compliance rate among physicians increased from 65.1% to 91.6% during the study period (p < 0.0001). More importantly in the succeeding 24 months after study completion, physician hand hygiene compliance remained >90% in every month.

Conclusions: Physician hand hygiene compliance increased as a consequence of the surveillance conducted by a full-time ICU team member, leading to a highly significant increase in the number of observations. In turn, this allowed for specific comparative monthly feedback to individual chiefs of service. Over the next 2 years after the study ended, these gains were sustained, suggesting an enduring culture change in physician behavior.

No MeSH data available.