Hand Hygiene Rewards Program at William Osler

Health System

•A Canadian study done in 2003 stated 220 000 patients are aff l icted with hospital acquired infections in

Canada every year

•8,000 to 12,000 of those individuals wil l die as a result of

acquiring a hospital acquired infection

Hand Hygiene Compliance

• Hand hygiene is very important to prevent and control the transmission of infections.

• Our data analysis from daily hand hygiene audits indicated our compliance rates were low when compared to the Ontario provincial average

Hand Hygiene Compliance

• Hand hygiene is very important to prevent and control the transmission of infections.

• Our data analysis from daily hand hygiene audits indicated our compliance rates were low when compared to the Ontario provincial average

What can we do???

• Introduction of Wash to Win rewards Campaign – May 7th 2012

• Phase I ran from May 2012 to September 2012 and targets were 75% before patient/patient environment contact and 80% after patient/patient environment contact.

• Phase II ran from October 2012 to December 2012 and targets were raised to 85% before patient/patient environment contact and 90% after patient/patient environment contact.

• Phase lll of the “wash to win “ is being implemented.

• A random draw will take place amongst the units that meet and sustain the targets for two consecutive months between January 2013 to December 2013.

• The program was implemented in partnership with regular staff education, daily auditing and monthly circulation of compliance rates among staff.

• Why do it? • To bring about behavioural and cultural

change in order to sustain improved hand hygiene among staff.

Prizes

• All inpatient units and emergency departments which met and sustained hand hygiene targets for two consecutive months won a monetary prize.

Results

• There was a sustained increase in Osler’s hand hygiene compliance rates in phase I.

• During phase II the targets were increased. At this point the compliance rate dropped

65 70 57

64 64 70 66 72 76 70 74 77 80 88 88 88 86 89

76 86 81

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Month

Corporate Hand Hygiene Compliance Rates Before initial patient/patient environment

contact Median =76

Rewards Program Phase 1

Rewards Program Phase 2

79 82 73 69

77 83 86 86 83 79 88 91 92 96 94 95 97 95 92 95 94

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Corporate Hand Hygiene Compliance Rates After initial patient/patient environment

contact Median =88

Rewards Program Phase 1

Rewards Program Phase 2

Total units Participated & Total Gifts:

• A total of 37 units participated in the “wash to win” rewards program. The IPAC team gave out 60 awards to the various units during May and September 2013

Lesson learned

• Positive reinforcement does change people’s behaviour.

• Rewards are most effective when it occurs immediately after the compliance rates have been published.

• When the program was started the targets should have been set to 100% for both ‘before and after patient/patient environment contact’

• The program should continue for 18-24 months.

• In order to increase public and staff awareness, monthly hand hygiene compliance posters have been placed on every unit. These are updated on a monthly basis.

Monthly Hand Hygiene posters

Conclusion

• When staff wash before patient contact everybody wins!

• Patient, staffs and visitors are kept safe and infection-free!

• References • World Health Organization Patient Safety: WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety

Challenge, Clean Care is Safer Care. Geneva Switzerland: World Health Organization; 2009. • Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Cardo DM. Estimating health care-associated

infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007 Mar-Apr;122(2):160-6. • Zoutman DE, Ford BD, Bryce E, Gourdeau M, Hébert G, Henderson E, Paton S; Canadian Hospital Epidemiology Committee;

Canadian Nosocomial Infection Surveillance Program; Health Canada. The state of infection surveillance and control in Canadian acute care hospitals. Am J Infect Control. 2003 Aug;31(5):266-72; discussion 272-3.

• Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hebert P, Majumdar SR, O’Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S,Tamblyn R: The Canadian Adverse Events Study: The incidence of adverse events among hospital patients in Canada. CMAJ 2004, 170:1678–1686.

• Samraj S, Westbury J, Pallett A, Rowen D. Compliance with hand hygiene in a genitourinary medicine department. Int J STD AIDS. 2008 Nov;19(11):782-3

• Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med. 1999 Apr 26;159(8):821-6

• Centre for Disease Control: Guideline for Hand Hygiene in Health-CareSettings-Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Morb Mortal Wkly Rep 2002, 51. http://www.cdc.gov/

• mmwr/pdf/rr/rr5116.pdf.Boyce JM, Pittett D: Guideline for hand hygiene in health-care settings:recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infection Control and Hospital Epidemiology 2002, 23:1–45.

• Public Health Ontario: Just Clean Your Hands - Your 4 Moments for HandHygiene. Public Health Ontario: Ontario Agency for Health Protection andPromotion; 2011. 7-8-2012.

• Earl ML, Jackson MM, Rickman LS: Improved rates of compliance with hand antisepsis guidelines: a three phase observational study. Am J Nurs 2001, 101:26–33.

• Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW: Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinian hospitals. Am J Infect Control 2003,31:85–92.

• Stern C, Gibb H: The use of behavioural reinforcement in the management