Hand Hygiene: Yes We Can!

As I have been rounding all over the hospital this last week on the inpatient infectious diseases consultation service, I have noticed healthcare workers reflexively hitting the alcohol foam dispensers on room entry to clean their hands. It appears that many don’t even think about it anymore; it’s just become part of what we do, much like fastening your seatbelt when getting into your car. In 2004, when we first started our hand hygiene campaign, our compliance rate was about 45%. In 2008, our hospital-wide compliance rate was 87% (over 32,000 hand hygiene opportunities observed). Details of our hand hygiene observation program were presented last week at the SHEA Meeting by Mike Stevens. Could our compliance rate be falsely elevated by the Hawthorne effect? Sure, but our 2003 rate was likely similarly affected. However, since our observers are often directed to areas of the hospital where compliance is known to be low or clusters of infections have occurred, some underestimation of the overall rate may also be occurring. Most healthcare epidemiologists believe that hand hygiene is the most important measure to prevent healthcare associated infections and I think that a strong hand hygiene program has to be the cornerstone of an effective infection prevention program. I’m a believer--we have seen a nearly 75% reduction in HAIs over the time our hand hygiene compliance has doubled, though we have implemented several other interventions in that time period that were likely also effective. There are still some who say that hand hygiene compliance cannot be driven to high levels. To that I say: Yes, we can. Yes, we have. But we still have more work to do.