Impact of a Successful Speaking Up Program on Health-Care Worker Hand Hygiene Behavior

Abstract

Background: Health-care worker (HCW) hand hygiene (HH) is the cornerstone of efforts to reduce hospital infections but remains low. Real-time mitigation of failures can increase process reliability to > 95% but has been challenging to implement for HH.

Objective: To sustainably improve HCW HH to > 95%.

Methods: A hospital-wide quality improvement initiative to improve HH was initiated in February 2012. HCW HH behavior was measured by covert direct observation utilizing multiple-trained HCW volunteers. HH compliance was defined as correct HH performed before and after contact with the patient or the patient's care area. Interventions focusing on leadership support, HCW knowledge, supply availability, and culture change were implemented using quality improvement science methodology. In February 2014, the hospital began the Speaking Up for Safety Program, which trained all HCWs to identify and mitigate HH failures at the moment of occurrence and addressed known barriers to speaking up.

Results: Between January 1, 2012, and January 31, 2016, there were 30,514 HH observations, averaging 627 observations per month (9% attending physicians, 12% resident physicians, 46% nurses, 33% other HCW types). HCW HH gradually increased from 75% to > 90% by December 2014. After the Speaking Up for Safety Program, HCW HH has been > 95% for 20 months. Physician HH compliance has been above 90% for over a year.

Conclusion: Creating a specific process for staff to speak up and prevent HH failures, as part of a multimodal improvement effort, can sustainably increase HCW HH above 95%.

Fig. 1.

Key driver diagram depicting the relationship between interventions to improve HCW hand hygiene and the improvement goal.

Fig. 2.

Annotated run chart showing hospital-wide hand hygiene compliance percentage by month from January 2012 through January 2016.

Fig. 3.

Annotated run chart showing hospital-wide hand hygiene compliance percentage by month for nurses from January 2012 through January 2016.

Fig. 4.

Annotated run chart showing hospital-wide hand hygiene compliance percentage by month for attending physicians from January 2012 through January 2016.

Fig. 5.

Annotated run chart showing hospital-wide hand hygiene compliance percentage by month for resident physicians from January 2012 through January 2016.

Fig. 6.

Annotated run chart showing hospital-wide hand hygiene compliance percentage by month for other HCW groups from January 2012 through January 2016. Other HCW groups include patient care technicians, respiratory therapists environmental services, medical students, and various other ancillary staff.