Nobody said compliance monitoring has to be dull
Catching good behavior, throwing pizza parties
Dear Editor:
For almost two years now, we have had an active, very fun, and effective hand hygiene monitoring program. It started out as a project to measure acquisition of significant pathogens after adding hand sanitizers and reinforcing hand hygiene on several patient care units. We had external funding to hire hand hygiene observers to measure compliance and received complementary hand sanitizer from a local manufacturer for the duration of the project.
We ICPs worked very closely with managers and staff on those units, and it was a great experience for them and us. When the project ended, we just couldn’t give up the momentum we had achieved. We enjoyed doing "shoe-leather" infection control, and the hand hygiene compliance numbers more than doubled on the units involved.
We then started working on how to achieve an organizationwide hand hygiene incentive program. First, we facilitated the bid for hand sanitizers and coordinated installation of dispensers throughout the organization.
When sanitizers were installed on a unit, we provided in-person inservices and/or provided inservice materials to promote use of the product and reinforce the importance of hand hygiene. We quickly realized that we had to continue the observer program and provide feedback to the patient care areas for our program to work. So we convinced our top administrators that such a program was valuable to the organization.
They approved funding for approximately 15 hours of observation each week. There are 12 patient care units where observations can be done. We meet monthly with managers from those units. We use humor, in major amounts, when presenting data and promoting compliance. We ensure that new employees and new house staff are thoroughly indoctrinated to the program during orientations.
Our associate hospital epidemiologist periodically meets with house staff and goes on candy bar rounds with us. In that regard, we received support from our rewards/recognition program to provide gastronomic awards such as:
1. candy bars with wrappers stating "caught in the act of performing good hand hygiene" that are given to employees caught doing the right thing by ICPs during our rounds;
2. pizza parties every three months for the three winning units in our "war on germs" that pits unit against unit for the best compliance figures. Both have been great incentives.
The "war on germs" was very competitive. I even had an MD director of a unit call me for consultation when the unit’s manager told him that physician lack of compliance was hurting their chances for a pizza party.
The increasing compliance supports the value of the program. Units have been able to show compliance rates far better than the baselines that we documented during the initial project; most have brought their monthly compliance rates up to above 60% consistently. There still is a lot of room for improvement, but it sure beats the baseline.
The winner of the intensive care unit division of the war on germs had an 88% average over three months. The other two division winners were 80% and 71% for the three months. The hospital rate (average of the 12 units) was 75% this April; it has dropped a bit since then, but we think it is just a summer slump.
Managers thoroughly have bought into the value of our program. All have devised unit- specific methods to increase compliance, including rounding with physicians, giving "warning tickets" to people they see not performing hand hygiene, and including compliance with hand hygiene in annual performance evaluations.
It was so much fun and gratifying to see one manager on her knees in the hallway yelling, "Yes! Yes!" to the ceiling when her unit finally hit 60%. Our administrators also are fully supportive; they had us present the program to the board of trustees, and they ask about hand hygiene on their quality rounds. For us, hand hygiene has become an institutional expectation, not an option — and we love it.
Submitted by: Barbara R. Mooney, RN, BSN, CIC
Coordinator, Hospital Epidemiology
University of Utah Hospitals & Clinics
Salt Lake City
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