Quality Improvement Project to Improve Hand Hygiene Compliance in a Level III Neonatal Intensive Care Unit

Area of Science:

• Healthcare Quality Improvement
• Infection Prevention and Control
• Neonatal Medicine

Background:

• Hand hygiene (HH) is critical for preventing infections in Neonatal Intensive Care Units (NICUs).
• Baseline HH compliance in this Level III NICU was significantly low (31.56%).
• Specific low-compliance moments included before/after glove use and unit entry/exit.

Purpose of the Study:

• To enhance hand hygiene compliance among healthcare workers (HCWs) in a Level III NICU.
• To evaluate the effectiveness of multiple Plan-Do-Study-Act (PDSA) cycles on HH practices.
• To identify barriers and facilitators for improving HH in the NICU setting.

Main Methods:

• A quality improvement project utilizing three two-month PDSA cycles.
• Interventions included HCW education, repeated education, and immediate performance feedback.
• Covert observations were used to collect HH compliance data.

Main Results:

• Overall HH compliance increased from 31.56% at baseline to 46.64% post-intervention.
• HCW education alone did not yield substantial improvements.
• Low compliance persisted during specific moments, such as before/after glove use and unit transitions.

Conclusions:

• Multi-faceted interventions, including leadership support and immediate feedback, are essential for improving NICU HH compliance.
• Addressing HCWs' false sense of security with gloves and involving staff in goal-setting are crucial.
• Future interventions should consider workload metrics and individual staff engagement to further elevate HH rates.