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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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3123 — Variation among Hand Hygiene Programs in the Veterans Health Administration

Reisinger HS, CADRE; Goedken CC, CADRE; Thomas JT, CADRE; Perencevich EN, CADRE;

Objectives:
Guidelines provide infection control teams with numerous recommendations to improve hand hygiene among healthcare workers and to monitor their progress in this area. The objective of this study is to describe and categorize hand hygiene programs"”including monitoring programs and interventions"”among infection control teams in the Veterans Health Administration, the largest integrated healthcare system in the US.

Methods:
An ethnographic study was conducted with infection control teams at six geographically dispersed VA Medical Centers (VAMCs). Individual and group semi-structured interviews, observations, and documentation of hand hygiene policies and procedures were completed. Transcripts, field notes, and policy documents were analyzed for thematic content to assist in characterizing individual hand hygiene programs.

Results:
Tremendous variation existed among the hand hygiene programs at 6 VAMCs. Each of the six infection control teams conducted hand hygiene monitoring using a different approach. Five used unique paper and pencil observation forms, while one site used an electronically-assisted monitoring system. All sites collected hand hygiene behaviors on entry and exit and consistently recorded location and date/time. Other details on the forms varied by site, including isolation status, healthcare worker type, personal protective equipment utilization, and method (e.g., soap and water). Monitoring programs also differed based on who conducted the observations, who was responsible for data entry and analysis, and whether and how they fed back the data. In regards to interventions, all sites described hospital-wide or unit-based hand hygiene campaigns that had occurred at their VAMC, but none had current campaigns. The most consistent intervention was education of staff; however, which staff and when the training occurred differed.

Implications:
Despite being part of a single healthcare system, hand hygiene programs varied considerably across six facilities. Next steps include linking the different hand hygiene program processes to outcome measures to test variations in effectiveness.

Impacts:
Characterizing different types of hand hygiene programs and linking them to outcome data could inform future guidelines and help determine if tailoring to the individual facility or more standardized approaches are more effective in improving hand hygiene.