Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study. (9th April 2020)

• Record Type: Journal Article
• Authors: Leis, Jerome A; Powis, Jeff E; McGeer, Allison; Ricciuto, Daniel R; Agnihotri, Tanya; Coyle, Natalie; Williams, Victoria; Moore, Christine; Salt, Natasha; Wong, Louis; McCreight, Liz; Sivaramakrishna, Sajeetha; Junaid, Shara; Cao, Xinghan; Muller, Matthew
• Is Part Of: Clinical infectious diseases. Volume 71:Number 10(2020)
• Page Start: e680
• Page End: e685
• Publication Date: 2020-04-09
• Subjects: hand hygiene -- healthcare-associated infection -- nosocomial infection -- electronic monitoring -- quality improvement; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa412
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking. Methods: A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada. The intervention involved daily HH reporting as measured by group electronic monitoring to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (percentage) between baseline and intervention. Secondary outcomes included transmission of antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. Results: After adjusting for the correlation within inpatient units and hospitals, there was a significant overall improvement in HH adherence associated with the intervention (incidence rate ratio [IRR], 1.73 [95% confidence interval {CI}, 1.47–1.99]; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1 395 450/4 544 144) to 37% (598 035/1 536 643) within 1 month, followed by consecutive incremental increases up to 53% (804 108/1 515 537) by 10 months ( P < .0001). There was a trend toward reduced healthcare-associated transmission of MRSA (IRR, 0.74 [95% CI, .53–1.04]; P = .08). Conclusions: The introduction of a system for group electronic monitoring led to rapid, significant improvements in HH performance within a 2-year period. This method offers significant advantages over direct observation for measurement and improvement of HH. Abstract : In this cluster-randomized quality improvement study of 26 inpatient units across 5 hospitals, introduction of electronic monitoring of hand hygiene resulted in a near-doubling of hand hygiene adherence associated with a trend toward reduced healthcare-associated transmission of methicillin-resistant Staphylococcus aureus .