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Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel

Published online by Cambridge University Press:  02 January 2015

Hanan Aboumatar ,
Polly Ristaino ,
Richard O. Davis ,
Carol B. Thompson ,
Lisa Maragakis ,
Sara Cosgrove ,
Beryl Rosenstein  and
Trish M. Perl
Hanan Aboumatar*
Affiliation:
Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, Maryland Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Polly Ristaino
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Richard O. Davis
Affiliation:
Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, Maryland
Carol B. Thompson
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Lisa Maragakis
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Sara Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Beryl Rosenstein
Affiliation:
Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
*
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, 601 North Caroline Street, Suite 2080, Baltimore, MD 21287 ([email protected])
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Abstract

Background.

Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.

Objective.

To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.

Design.

Time series design.

Setting

Our study was conducted at a tertiary care academic center.

Participants.

Hospital healthcare personnel.

Methods.

We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by “undercover” observers.

Results.

Overall hand hygiene compliance increased by 2-fold after full program implementation (P<.001), and this increase was sustained over a 20-month follow-up period (P< .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53–4.23; P< .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P<.001), from 38% to 62% among medical providers (P<.001), and from 27% to 75% among environmental services staff (P<.001).

Conclusions.

Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.

Infect Control Hosp Epidemiol 2012;33(2):144-151

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 144 - 151
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Pittet, D, Allegranzi, B, Boyce, J, World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.CrossRefGoogle ScholarPubMed
2.Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
3.Stone, PW. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res 2009;9:417–422.CrossRefGoogle ScholarPubMed
4.Siegel, JD, Rhinehart, E, Jackson, MP, Chiarello, L; the Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed October 12, 2009.Google Scholar
5.Grundmann, H, Aires-de-Sousa, M, Boyce, J, Tiemersma, E. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public-health threat. Lancet 2006;368:874–885.Google Scholar
6.Bhalla, A, Pultz, NJ, Gries, DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.CrossRefGoogle ScholarPubMed
7.Hardy, KJ, Oppenheim, BA, Gossain, S, Gao, F, Hawkey, PM. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006;27:127–132.CrossRefGoogle ScholarPubMed
8.Maragakis, LL, Cosgrove, SE, Song, X, et al. An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA 2004;292:3006–3011.Google Scholar
9.Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.CrossRefGoogle ScholarPubMed
10.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection control programme. Lancet 2000;356:1307–1312.Google Scholar
11.Barrera, L, Zingg, W, Mendez, F, Pittet, D. Effectiveness of a hand hygiene promotion strategy using alcohol-based handrub in 6 intensive care units in Colombia. Am J Infect Control 2011;39:633–639.Google Scholar
12.Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee (HICPAQ/Society for Healthcare Epidemiology of America (SHEA)/Association for Professionals in Infection Control (APIC)/Infectious Diseases Society of America (IDSA) Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infect Control Hosp Epidemiol 2002;23:S3–S40.Google Scholar
13.Green, LW, Costagliola, D, Chwalow, AJ. Educational diagnosis and evaluation of educational strategies (PRECEDE model): practical methodology for inducing changes in behavior and health status. J Annu Diabetol Hotel Dieu 1991:227–240.Google ScholarPubMed
14.Green, LW, Kreuter, MW. Health Promotion Planning: An Educational and Ecological Approach. Mountain View, CA: Mayfield, 1999.Google Scholar
15.Center for Innovation in Quality Patient Care Web site, Johns Hopkins Medicine. http://www.hopkinsmedicine.org/innovation_quality_patient_care/areas_expertise/infections_complications/healthcarefiles/player.html. Accessed September 20, 2011.Google Scholar
16.Hysong, SJ. Meta-analysis: audit and feedback features impact effectiveness on care quality. Med Care 2009;47:356–363.Google Scholar
17.McAteer, J, Stone, S, Fuller, C, et al. Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT). J Hosp Infect 2008;68:222–229.Google Scholar
18.Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Isolation status and voice prompts improve hand hygiene. Am J Infect Control 2007;35:470–476.Google Scholar
19.Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Crit Care Med 2004;32:358–363.Google Scholar