A multicenter study using positive deviance for improving hand hygiene compliance - 30/10/13

Doi : 10.1016/j.ajic.2013.05.013

Alexandre R. Marra, MD ^a,^b,^⁎ , Danilo Teixeira Noritomi, MD ^c, Adilson J. Westheimer Cavalcante, MD ^d, Thiago Zinsly Sampaio Camargo, MD ^a, Renata Puzzo Bortoleto, MD ^e, Marcelino Souza Durao Junior, MD ^a,^b, Anucha Apisarnthanarak, MD ^f, Claudia Laselva, MD ^a, Walace de Souza Pimentel, MD ^a,^b, Leonardo Jose Rolim Ferraz, MD ^a,^g, Maria Fátima dos Santos Cardoso, RN ^a, Elivane da Silva Victor, PhD ^a, Oscar Fernando Pavão dos Santos, MD ^a,^b, Miguel Cendoroglo Neto, MD ^a,^b, Michael B. Edmond, MD, MPH, MPA ^h
Positive Deviance For Hand Hygiene Study Group^†
The Positive Deviance for Hand Hygiene Study Group members are Mirian de Freitas Dalben, MD,^c Claudia Garcia P. Fabíola, RN,^c Maria Inês Bratfisch, RN,^d Luci Correa, MD,^a,b Denis Faria Moura Junior, RN,^a Neide Marcela Lucinio, RN,^a Maria Aparecida Alves, RN,^a Vanessa Jonas Cardoso, RN,^a Ícaro Boszczowski, MD,^e Antonio Claudio do Amaral Baruzzi, MD,^e Edimar Junio Sgoti, RN,^b Eduardo Alexandrino Servolo Medeiros, MD,^b Daniela Escudero, MD,^b Uayporn Pinitchai, RN,^f Lidiane Soares Sodre da Costa, RN,^a Cristina Vogel, RN,^a Julia Yaeko Kawagoe, RN,^a Marcos Rodrigues Gouvêa, PhD,^a and Patricia Rady Muller, MD.^g
^a Hospital Israelita Albert Einstein, São Paulo, Brazil
^b Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
^c Hospital Paulistano, São Paulo, Brazil
^d Hospital Heliopolis, São Paulo, Brazil
^e Hospital Municipal Dr Moysés Deutsch-MBoi Mirim, São Paulo, Brazil
^f Thammasat University Hospital, Khlong Luang, Thailand
^g Hospital Brigadeiro, São Paulo, Brazil
^h Virginia Commonwealth University, Richmond, VA

^∗Address correspondence to Alexandre R. Marra, MD, Avenue Albert Einstein, 627 Bloco A1, 1o andar, Room 108, Morumbi, São Paulo 05651-901, Brazil.

Abstract

Background

Positive deviance (PD) can be a strategy for the improvement of hand hygiene (HH) compliance.

Methods

This study was conducted in 8 intensive care units and 1 ward at 7 tertiary care, private, and public hospitals. Phase 1 was a 3-month baseline period (from August to October 2011) in which HH counts were performed by observers using iPods (iScrub program). From November 2011 to July 2012, phase 2, a PD intervention was performed in all the participating centers. We evaluated the consumption of HH products (alcohol gel and chlorhexidine) and the incidence density of health care-associated infections.

Results

There was a total of 5,791 HH observations in the preintervention phase and 11,724 HH observations in the intervention phase (PD). A statistically significant difference was found in overall HH compliance with 46.5% in the preintervention phase and 62.0% in the PD phase (P < .001). There was a statistically significant reduction in the incidence of density of device-associated infections per 1,000 patient-days and also in the median of length of stay between the preintervention phase and the PD phase (13.2 vs 7.5 per 1,000 patient-days, respectively, P = .039; and 11.0 vs 6.8 days, respectively, P < .001, respectively).

Conclusion

PD demonstrated great promise for improving HH in multiple inpatient settings and was associated with a decrease in the median length of stay and the incidence of device-associated HAIs.

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Key Words : Safety patient, Health care-associated infection

Plan

Validation training for HH observation

Study sample and HH compliance

Discussion

Conflicts of interest: None to report.

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Vol 41 - N° 11

P. 984-988 - novembre 2013 Retour au numéro

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A multicenter study using positive deviance for improving hand hygiene compliance - 30/10/13

Abstract

Background

Methods

Results

Conclusion

Plan

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