A multicenter study using positive deviance for improving hand hygiene compliance

• Published in: American journal of infection control Vol. 41; no. 11; pp. 984 - 988
• Main Authors: Marra, Alexandre R., MD, Noritomi, Danilo Teixeira, MD, Westheimer Cavalcante, Adilson J., MD, Sampaio Camargo, Thiago Zinsly, MD, Bortoleto, Renata Puzzo, MD, Durao Junior, Marcelino Souza, MD, Apisarnthanarak, Anucha, MD, Laselva, Claudia, MD, de Souza Pimentel, Walace, MD, Rolim Ferraz, Leonardo Jose, MD, Fátima dos Santos Cardoso, Maria, RN, da Silva Victor, Elivane, PhD, Pavão dos Santos, Oscar Fernando, MD, Neto, Miguel Cendoroglo, MD, Edmond, Michael B., MD, MPH, MPA
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-2013; Elsevier; Mosby-Year Book, Inc
• Subjects: Alcohol use; Biological and medical sciences; Compliance; Cross Infection - epidemiology; Cross Infection - prevention & control; Epidemiology. Vaccinations; General aspects; Guideline Adherence; Hand Hygiene; Health care-associated infection; Hospitals; Human infectious diseases. Experimental studies and models; Humans; Infection Control; Infections; Infectious Disease; Infectious diseases; Intervention; Medical sciences; Safety patient; Brazil; Health care-associated infection; Safety patient; Prevention; Human; Nosocomial infection; Compliance; Multicenter study; Check; Hand; Hygiene
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2013.05.013

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.