Targeting the root: How behavioral feedback and cultural engagement transformed hand hygiene at a tertiary acute care...

Hand hygiene is vital to infection prevention, but sustaining high compliance remains an ongoing challenge. This project aimed to determine if a culturally focused hand hygiene program, leveraging existing resources and context-driven data, could sustain high compliance in an acute care hospital setting.

In June 2023, our tertiary acute care hospital implemented a hand hygiene program targeting roots of non-compliance. Light-duty nurses and patient care technicians observed compliance through security cameras, provided real-time feedback, and acted as cultural change agents. Context-specific data were leveraged to create targeted education and recognition programs. Results were analyzed using an interrupted time series analysis, logistic regression, and a decision tree algorithm to assess impact and predictors of compliance.

191,403 observations were collected across 11 inpatient units. Overall post-implementation compliance improved by 11.6% (effect size: 0.34). Improvements were observed across all units, roles, and shifts. Significant predictors of compliance were identified, including staff roles and shifts. Improvements were resilient to the hourly census and showed a 54% reduction in the variance of compliance.

Our program sustainably improved and stabilized hand hygiene compliance. The approach offers a practical and scalable model for institutions seeking to overcome common challenges to achieve sustainable compliance.