Successful hand hygiene intitiative reduces healthcare-associated infections

In the December edition of BMJ Quality and Safety, the headline article reports on the impact of a hand hygiene initiative on compliance and healthcare-associated infections:

Impact of hospital-wide hand hygiene initiative on healthcare-associated nfections: results of an interrupted time series. Kirkland et al.

Although all healthcare professionals know hand hygiene reduces patient infections, few comply and efforts to increase this have failed.

The Kirkland et al report describes the research carried out at a hospital in New Hampshire aiming to increase hand hygiene and decrease healthcare-associated infections through five interventions:

• leadership and accountability
• measurement and feedback
• hand sanitiser availability
• education and training
• marketing and communication.

By most measures the interventions were a success: hand hygiene increased from 41% to 87%. It also continued to increase to 91% the following year, suggesting it has the potential to be sustained. The report’s authors believe that the interventions raised awareness of the problem and this was enough to change behaviour – physicians reported that regularly seeing data linking better hand hygiene to reduced infections was important.

There was also a reduction in healthcare-associated infections, down from 4.8 to 3.3 per 1,000 inpatient days.

This study achieved similar results to those that came before, such as studies by Lederer et al and Doron et al. However, it built on this work by analysing changes in infections related to the operating room and using this as a control. By comparing the lack of changes in the control - where the interventions would be expected to have no impact - to the improvements in healthcare associated infections, we can see that this is driven by an improvement in hand hygiene.

The study also showed that infection rates lag behind hand hygiene improvement, suggesting a minimum level of HH compliance and/or a continuous period of high performance are needed before there is a reduction in infections. Other studies may not have reached this level or continued measuring for long enough to record an improvement.

The Health Foundation co-owns the BMJ Quality and Safety with the BMJ Group. We aim to advance research and inspire fresh thinking in a rapidly expanding area of interest to clinicians, medical managers, and policy makers around the globe.

Find out more about the BMJ Quality and Safety at qualitysafety.bmj.com