Multicenter Improvement Study Using Electronic Hand Hygiene Monitoring to Prevent Healthcare-associated Infectiions WITH SMH MULLER
Quality and Safety
SHS-17-005 This multicentre stepped wedge trial of 26 medical-surgical inpatient units across 5 Ontario hospitals found that electronic hand hygiene (HH) monitoring is a more accurate and effective method for measuring hand hygiene compliance than traditional human observer monitoring. The study also showed that pairing accurate measurement of HH compliance with unit-led improvement strategies is key to improving hand hygiene compliance.
SHS-17-005 Background: HH compliance is the single most important intervention to prevent Healthcare-associated infections (HCAIs) and has been a publicly reported key safety indicator in Ontario. The current approach to measuring HH relies on human observers who rapidly become recognized by staff, resulting in inflation of reported adherence. This study aims to use an electronic HH monitoring (e-monitoring) system to measure and evaluate the impact of improvement strategies on HH compliance and associated prevention of HCAIs. Methods: A multicenter stepped wedge randomized trial is underway involving 26 medical/surgical inpatient units across 5 hospitals in Ontario. Units were randomized to launch e-monitoring combined with a multimodal improvement strategy including real-time performance feedback, setting improvement targets and unit-led QI huddles to inform iterative changes in practice. The primary outcome is relative change in HH compliance from baseline as measured by e-monitoring system and the secondary outcomes include incidence of nosocomial transmission of Methicillin Resistant Staphylococcus Aureus (MRSA), Clostridium difficile infection, and nosocomial blood stream infections compared to 3 years prior to the intervention. Results: At baseline, overall monthly HH compliance was 29% (1395450/4544144) and stable across 3-months. Within 1-month, HH improved to 37% (598035/1536643) followed by consecutive monthly incremental increases up to 50% (749336/ 1481383) by 9-months relative to the intervention. By 6-months relative to intervention a reduction in nosocomial transmission of MRSA was noted (Incident Rate Ratio 0.70, 95% CI, 0.49-1.0; p=0.06). Conclusion: Pairing accurate measurement of HH compliance with unit-led improvement strategies led to near doubling of HH compliance within 10-months of intervention.