Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement

Abstract

Background: Hospital-wide multifaceted approaches can improve hand hygiene compliance in health care workers. However, the true effects of monitoring and feedback interventions are not clear.

Methods: Hand hygiene compliance was evaluated by applying direct observation techniques over 5 years (2005-2009) in a tertiary care general hospital in Japan. The observed results were periodically reported as feedback to the health care workers.

Results: The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and was sustained at approximately 60% through the completion of the study. The compliance rate for the indication before entering the room increased from 2005 to 2009 (P = .005). The compliance rates for 4 before patient contact indications increased from 2005 to 2009 (P = .002). The combined compliance rate for the 6 indications with the lowest compliance rates in 2005 increased from 2005 to 2009 (P = .001).

Conclusions: Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance that was sustained over 5 years through the completion of the study. Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve the overall compliance.

Keywords: Direct observation; Hand hygiene; Infection control; Standard precaution.