230 - Increasing hand hygiene compliance in a pediatric hospital with educational and behavioral economics strategies

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 230
Publication Number: 230.45

Raquel Giacomelli Cao, Nationwide Children's Hospital, Columbus, OH, United States; Kali Broussard, Nationwide Children's Hospital, Columbus, OH, United States; Diego A. Cruz Vidal, Nationwide Children's Hospital, Columbus, OH, United States; Payal M.. Patel, Nationwide Children's Hospital, Columbus, OH, United States; Jack Stevens, PhD, Nationwide Children's Hospital/The Ohio State University, Columbus, OH, United States; Katia Camille. Halabi, Nationwide Children's Hospital, Columbus, OH, United States; Matthew Washam, Nationwide Children's Hospital, Columbus, OH, United States

Presenting Author(s)

Raquel Giacomelli Cao, MD PhD (she/her/hers)

ID fellow
Nationwide Children's Hospital
Columbus, Ohio, United States

Background: Hand hygiene (HH) is an essential infection control strategy linked to decreased rates of nosocomial infections, including catheter-related bloodstream infections and the spread of multi-drug resistant organisms, yet compliance with the World Health Organization guidelines remains a challenge. Following an update in the methodology to record compliance via covert observations in the Spring of 2021, a new baseline compliance rate was established.

Objective: The aim of this quality improvement (QI) project was to increase and sustain overall HH compliance from 73% to greater than or equal to 90% by July of 2022 in a pediatric inpatient setting.

Design/Methods:

This was a quality improvement project that took place at Nationwide Children’s Hospital in Columbus, Ohio, from July of 2021 to July of 2022. A multi-disciplinary team was convened to improve HH compliance across the organization. Key drivers were identified to include healthcare worker (HCW) knowledge of WHO’s 5 moments of HH, staff awareness of compliance data, and incorporating behavioral economics and appreciative inquiry strategies to improve HH compliance. Interventions were designed and implemented using the Plan-Do-Study-Act cycle and included enhanced education via infection control staff; positive coaching and reinforcement with rewards sent by leadership for compliant observations; enhanced signage in clinical areas, including mirror clings doorway signs, and World Hand Hygiene Day promotion with educational activities and prizes (Figure 1). Compliance with HH was monitored via covert observation.

Results:

Retrospective data from May to July of 2021 showed overall HH compliance of 73%. A series of interventions were implemented from July 2021 through December 2021 resulting in a center line shift to 90% compliance (Figure 2). Compliance has been maintained throughout 2022 with periodic ongoing education.

Conclusion(s):

HH compliance rates were improved in a pediatric healthcare setting using enhanced education combined with behavioral economics. Ongoing evaluation is needed to further qualify the durability of these results.