ISSUE: Compliance with hand hygiene practices and expanded precautions are two means of reducing healthcare-associated infections (HAIs). Monitoring of these performance indicators can be challenging in a facility with over 7000 employees and 80–100 patients on expanded precautions daily.

PROJECT: Observations of hand hygiene are completed by registered nurses (RNs) of the supplemental staffing (SST) and IV teams. The RN makes random observations of hand hygiene behaviors of healthcare workers (HCWs) while performing his/her job duties. To monitor isolation, the infection control practitioners (ICPs) make weekly rounds of the units to assess compliance with established protocols. The ICP documents commendations and errors and communicates directly with available staff members. The manager is responsible for following up with staff to correct noncompliance and documenting actions taken. The data from both forms of monitoring is compiled into a quarterly report that includes unit specific HAI methicillin-resistant Staphylococcus aureus infection/colonization rates. The report is disseminated to directors, managers, and staff to communicate unit compliance with infection control practices and identify areas for improvement. Focused education is conducted for specific identified issues, such as the education campaign directed at increasing physician hand hygiene compliance.

RESULTS: A total of 1124 hand hygiene observations of individual HCWs were completed between January and December 2004. Observations indicate physician compliance is 32.0%, while total HCW compliance is 68.7%. Hand hygiene education focusing on physicians increased their compliance to 59.5%, which is a statistically significant improvement (p=0.01). For isolation monitoring, 2095 commendations and 1302 errors have been documented. An increasing trend of the amount of commendations given each quarter can be noted since initiation of monitoring in October 2003.

LESSONS LEARNED: Monitoring with feedback is an effective way of increasing compliance with infection control practices if done continuously. Utilizing SST and the IV Team in hand hygiene monitoring is an easy, time-efficient method of obtaining data. When attempting to monitor infection control practices at a large facility, the use of simple, standardized forms and uniform education of the monitoring process are key factors in the consistency of the data collected.