Targeted interventions for compliance with hand hygiene measures in the rehabilitation setting

Purpose:
Within a rehabilitation facility, there are special challenges to compliance with the hand hygiene measures recommended by the World Health Organization. Ongoing assessment and evaluation were needed in order to implement interventions that made sense in this environment, and impacted outcomes.

Significance:
Hand washing is a key factor in infection prevention. Healthcare-associated infections are among the American Nurses Association's National Database of Nursing Quality Indicators that are impacted by compliance with hand hygiene. Quality of care improves when staff adopt best practices in this area.

Strategy and Implementation:
The Center for Transforming Healthcare posted pilot project results and methods, including their Targeted Solutions Tool, on The Joint Commission's website. Our five rehabilitation units and adjacent clinic site joined 11 System inpatient facilities in replicating this project, beginning in October, 2010. Monthly hand hygiene rates were obtained utilizing “secret shoppers”, who completed written reports of actions seen during room entry or exit. This initiative required management-level support for rotating training of staff members to cover all shifts, prior to data collection. Managers provided “just in time” coaching of staff members observed out of compliance. Reporting of contributing factors aided in planning interventions. Policies for clinical and support staff were clarified, signage posted, and staff educated and informed of progress. This effort has become part of our safety culture, as employees are empowered to support best practice.

Evaluation:
Baseline compliance rate for the use of hand hygiene measures was 32%, as of May 31st, 2011. With education, assessment and planning of appropriate interventions, compliance rose beyond our goal of a 30% improvement in one year. We now average above 70%, and continue to add program innovations.

Implications for Practice:
Our main finding was that the doorway to a client's room was not considered by staff a significant safety stop for hand hygiene. Clients' wheelchair mobility can further confuse this issue. We hope our methods can be adopted by others seeking innovative solutions in long-term care environments.