We do a lot of blogging about hand hygiene, and Eli frequently points out the dearth of well-designed studies examining improvement approaches and/or the relationship between HH improvement and reduced infection rates.
In that context, I’d like to recommend this quasi-experimental study from Kathy Kirkland and her colleagues at Dartmouth, published last month in the BMJ Quality & Safety journal. Eli can inform us as to whether it would have “made the cut” for the 2011 Cochrane Review, but I really like this report. The interventions and setting are clearly described, more than one measure of HH is used (direct observation + product use), infection rates are reported over the entire time period, and the discussion section is thoughtful.
There are limitations to the work, but I encourage those who haven’t yet seen it to read it. Mike can add his experience here, as I think his group does more monthly observations, and has had a similar HH journey. I’ve also long been skeptical that rates of 90% can be achieved or sustained in settings where observations are truly clandestine (as I think in most hospitals the HH observers quickly become quite familiar to unit personnel). I’d love to be disabused of this skepticism, if it is indeed misplaced.
Figure from Kirkland KB, et al. BMJ Qual Saf 2012;21:1019-26.