QAPI 117 - Investigating Individual Hand Hygiene Improvements and Effect on Hospital-acquired Infections Using an Electronic Hand Hygiene Monitoring System: A Long-term Follow-up Study

Background: Challenges remain to sustain the improvements in hand hygiene (HH) interventions. There is a need to identify the most effective long-term interventions. Individual response data could play an important role by getting insights into the facilitators and barriers to the interventions on an individual HCW (healthcare worker) level. This study investigated the effect of two feedback interventions provided by an electronic hand hygiene monitoring system (EHHMS) on sustained improvement and prevention of hospital-acquired bloodstream infections (HABSI) and further examined the group and individual response over time.

Methods: We collected hand hygiene compliance (HHC) data by monitoring 142 caregivers and 39 doctors over 27 months via EHHMS and a cloud-based solution. The differences in infection incidence rates were assessed using the log-rank test with two-sided P-values < 0.05 considered statistically significant. We stratified HCWs into four groups based on their baseline performance to assess predicted responsiveness to the interventions.

Results: The number of HABSI cases was significantly reduced from 14 cases per 10,000 patient days (95% CI, 9–21) to 4 cases per 10,000 patient days (95% CI, 2–11) during the intervention period (P=0.01). The analysis of individual and group performance showed that nearly all HCWs significantly improved their HHC, with only a few constantly having low HHC (Fig. 1). The group with low performance during baseline improved less than the other groups when exposed to individual feedback with an average change in weekly HHC of 1.0% compared to 2.2% and 3.5% in the moderate low and moderate high-performance groups (Table 1).

Conclusions: The EHHMS interventions successfully sustained the HHC improvements and reduced the HABSI. Individual HHC data showed that all HCWs, except a few, responded to the interventions. However, the two low-performance groups during baseline never reached the same HHC levels as those in the high-performance groups, indicating a potential for further improvement.