A multicenter study using positive deviance for improving hand hygiene compliance.

BACKGROUND: Positive deviance (PD) can be a strategy for the improvement of hand hygiene (HH) compliance. METHODS: This study was conducted in 8 intensive care units and 1 ward at 7 tertiary care, private, and public hospitals. Phase 1 was a 3-month baseline period (from August to October 2011) in which HH counts were performed by observers using iPods (iScrub program). From November 2011 to July 2012, phase 2, a PD intervention was performed in all the participating centers. We evaluated the consumption of HH products (alcohol gel and chlorhexidine) and the incidence density of health care-associated infections. RESULTS: There was a total of 5,791 HH observations in the preintervention phase and 11,724 HH observations in the intervention phase (PD). A statistically significant difference was found in overall HH compliance with 46.5% in the preintervention phase and 62.0% in the PD phase (P < .001). There was a statistically significant reduction in the incidence of density of device-associated infections per 1,000 patient-days and also in the median of length of stay between the preintervention phase and the PD phase (13.2 vs 7.5 per 1,000 patient-days, respectively, P = .039; and 11.0 vs 6.8 days, respectively, P < .001, respectively). CONCLUSION: PD demonstrated great promise for improving HH in multiple inpatient settings and was associated with a decrease in the median length of stay and the incidence of device-associated HAIs.

Measuring hand hygiene compliance in a hematology-oncology unit: a comparative study of methodologies.

BACKGROUND: In managing hematology-oncology patients, there is a great opportunity for performing hand hygiene (HH). METHODS: Over a 4-month period, we compared HH compliance measurement by 3 different methods: direct observation, electronic handwash counter for alcohol gel, and measuring the volume of product used (alcohol gel) in a 40-bed hematology-oncology unit at a tertiary care, private hospital. RESULTS: There were 388 directly observed opportunities for HH, and the overall HH compliance rate was 84.5%. A total of 235,923 HH episodes was recorded by the electronic devices. The mean HH episodes per patient-day was 77.7. There were 91.1 mL of alcohol gel used per patient-day in the unit. The correlation and P value between the percentage of HH compliance and HH episodes per 1,000 patient-days were ρ = 0.442 and P = .076, respectively. The correlation and P value between HH episodes per patient-days and alcohol gel consumption in milliliters per patient-days were ρ = 0.142 and P = .586. CONCLUSION: HH compliance was high in this unit. Direct observation, although useful, has many drawbacks. Other measures must be considered, such as electronic devices and measurement of volume use per patient-day to stimulate health care workers to increase and sustain HH compliance.