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Hand-hygiene Rates Improved Through Variety of Reinforcement Styles

Matt Phillion, for HealthLeaders Media, November 6, 2009

It takes more than one method to bring a hospital's hand-hygiene compliance rate up over 90%. At Barnes-Jewish St. Peters Hospital (BJSPH) in St. Peters, MO, it was a matter of trial and error to reach its compliance goal.

"We started collecting hand-hygiene observations back in 2004," says Kathleen Dougherty, RN, MSN, manager of professional practice and leadership development at BJSPH. "We wanted to see where we were with compliance for guidelines from the Centers for Disease Control and Prevention."

The organization took several leaps forward over the next few years, but it was in 2007 they found several tactics that truly brought them closer to the level of compliance they were looking for.

You've been spotted

"In 2007, we knew we had to do more, and we wanted to do more," says Dougherty. "We wanted to be at 90% hand-hygiene compliance by the end of that year."

BJSPH increased frequency of the audits to at least 100 a month.

"In February 2007, after a brief discussion with a Joint Commission surveyor, we learned of the idea to use cards as a method of feedback during audits. We tool this idea and developed it further, into a very simple, but highly effective, concept: ‘You've been Spotted' cards."

These cards—adorned with a Dalmatian to go along with the "spotted" theme—came in two varieties. At a distance, they appeared indistinguishable, but up close the two varieties were distinctly different.

For positive reinforcement, some of the cards were flagged for incidents where the receiver has been spotted using good hand-hygiene practices. These cards includes a $2 coupon good in the hospital cafeteria or gift shop—enough for a cup of coffee or candy bar, or they can be saved up to buy lunch. Funding for these coupons came from the infection prevention budget.

On the spot

And then there are the other cards, which read, "We are putting you on the spot for not using hand hygiene."

The reason the cards look nearly identical is to prevent any sort of embarrassing scene for the people involved. It's impossible to tell from a few feet away whether you've received a positive card or negative.

"We needed something non-confrontational," says Dougherty. "We wanted something with positive reinforcement, but also something to notify you if you got caught. We didn't want this to be a public display."

The dynamic is an interesting one—especially because the auditors can be from any area of the hospital hierarchy. Secretaries have had to give cards to physicians, lab techs to nurses.

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