ISSUE: Hand hygiene is critical in preventing infections among neonatal intensive care unit (NICU) patients. The Centers for Disease Control and Prevention (CDC) has reported adherence of healthcare workers to hand hygiene practice to be poor, with an overall average of 40%. The NICU infection prevention committee of our clinic initiated a hand hygiene awareness program in conjunction with the Vermont Oxford Network's Quality Improvement Collaborative for Reducing Nosocomial Infections in the NICU.

PROJECT: The performance improvement cycle “plan, do, study, act” (PDSA) was used to guide the HH awareness program. An observational HH audit tool was created to assess compliance among physicians (MDs), nurses (RNs), and respiratory therapists (RTs) before and after patient care contact. Staff members were informed that unidentified coworkers would conduct random observations. Baseline HH compliance rates were established. Staff members were educated on the importance of HH in reducing nosocomial infections in the NICU. In addition, current bloodstream infection (BSI) rates/1000 central venous catheter (CVC) days were posted and emphasized for assimilation into practice. Observations were conducted, at random, over a 4-month period following the start of the program.

RESULTS: Baseline HH audits revealed that prior to patient contact MDs, RNs, and RTs compliance rates were 100%, 34.5%, and 35.7%, respectively. Baseline HH audits revealed that after patient contact MDs, RNs, and RT compliance rates were 50%, 46.6%, and 71.4%, respectively. HH compliance fluctuated during this test period. However, there was a marked overall improvement among all staff members.

LESSONS LEARNED: Using this “spy” approach, we were able to find areas of weakness in staff compliance with HH. Staff members were re-educated on the potential for patient-to-patient and environmental transmission of pathogens.