Tennessee hospital drastically dropped infection rates through hand-hygiene initiative

When a doctor noticed the physicians and staff tending to his wife after a double knee replacement weren't washing their hands before interacting with her, he worked to do something about it, Yahoo News reported.

Gerald Hickson, M.D., the senior vice president for quality, safety and risk prevention at Vanderbilt University Medical Center, which includes the hospital where his wife received treatment, saw more than 60 instances where staff could have provided safer care, according to the article. Hickson reported his findings to Tom Talbot, M.D., VUMC's chief epidemiologist. With Hickson, Talbot created Operation Clean Hands, a  hand-hygiene initiative at Vanderbilt University Hospital starting in 2009. 

The hospital installed additional hand sanitizer dispensers at the entrance and exit of every patient's room, and instructed staff to clean their hands before and after every interaction with patients. The hospital also added moisturizing lotion dispensers to address complaints of irritated skin because of the antiseptic. Since then, hand-washing rates at Vanderbilt jumped from 58 percent to 97 percent; while infections rates dropped: urinary tract infections related to catheters in intensive care units fell 33 percent; pneumonia linked to ventilators declined by 61 percent; and bloodstream infections associated with central lines dropped by 80 percent in ICUs.

Talbot also enforced the program through communication and shared accountability up and down the staff hierarchy. The hospital educated receptionists, medical students, surgeons and every staff member in between, on the link between hand washing and preventable infections, according to the article. Each department elected one observer who monitored and documented hand washing 20 times a month. The hospital posted hand-washing scores for each department every month in break rooms and other staff areas so everyone could see how his or her team ranked.

The program stressed that anyone should feel comfortable asking any other staff member to wash their hands, with an accountability pyramid to address any poor responses or behavior, according to the article. If a department underperformed, Talbot would send an intervention letter and high-level staff would develop an action plan, Yahoo News reported.

The initiatives weren't just good for patients and infection rates, but for the hospital's bottom line as well. Hickson and Talbot told department leaders that if hand-washing rates reached the hospital's target goal, their divisions would get back 2.5 percent of the cost of malpractice insurance premiums, according to the article.  

Other hospitals take different approaches. For example, Long Island's North Shore University Hospital has installed motion sensors that trigger a video camera whenever someone enters an intensive care unit room so workers in India can check to make sure doctors and nurses are washing their hands, FierceHealthcare previously reported.

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