Illuminating Hand Hygiene Practice: Strengthening the Foundation to Infection Prevention in the NICU

Hospital-acquired infections (HAIs) are among the leading causes of morbidity and mortality in the NICU. Adhering to proper hand hygiene compliance and technique is one of the most effective ways to minimize HAIs and create a safer environment for patients, their families, and staff. This quality improvement (QI) initiative aimed to audit hand washing quality in the NICU and ensure consistent adherence to proper techniques by all staff to reduce the incidence of HAIs. An increase in unit infections and high staff turnover prompted the project. This project was carried out over two Plan-Do-Study-Act (PDSA) cycles to evaluate the effectiveness of hand washing. All health care professionals entering the NICU applied glow lotion to their hands before washing. A glow light illuminated any missed areas, and an auditor collected data on each instance of participation. The material from the audit focused on : (a) the percentage of people who had glowing areas after hand washing (indicating missed germs) and no glowing areas after hand washing (indicating quality hand washing, eliminating germs); and (b) the number of missed hand washing areas and locations. At the end of this project, the proportion of participants with no glowing areas increased from 19.7 to 37%. Similarly, improvements were also seen in the number of glowing areas. The proportion of those with more than two missed areas decreased from 39.6 to 20.7%, again indicating that health care professionals were performing hand hygiene more effectively. It was noted that, although improvements were made, some staff still had one glowing area after hand washing, indicating that ongoing intermittent auditing of hand hygiene quality is pivotal. This back-to-basics activity demonstrates how health care professionals can improve the quality of their hand washing, thereby reducing the spread of infections in health care settings. It should be everyone's responsibility to ensure effective hand washing to protect those most vulnerable. Continued multidisciplinary education and audits are necessary to monitor compliance.