P2D252: Quality Improvement Project to Improve Compliance with Hand Hygiene in a Level III NICU

Purpose/Objectives: Healthcare-Associated-Infections (HAIs) are one of the most common complications of healthcare, with a significant economic impact. Neonatal Intensive Care Units (NICU) are at high risk for HAIs. Hand hygiene (HH) is a simple and effective measure to decrease these infections. Our aim is to improve compliance with HH in the NICU at NYC Health + Hospitals, Kings County, by 20% within a six-month period.

Design/Methods: An interdisciplinary team was created to assess HH compliance in the unit by covert observations of the Health Care Workers (HCW) including physicians, nurses and respiratory therapists. Nine HH opportunities were observed: a) before touching patient b) after touching patient c) before a clean/aseptic procedure d) after body fluid exposure e) after touching patient surroundings f) at entry into unit g) at exit from unit h) before wearing gloves i) after removing gloves. Baseline compliance at these opportunities ranged from 6% to 90%, with notably low compliance at five of them (Table 1). These were addressed through HCW education using the “five moments” model for HH by WHO and discussion of the importance and misconceptions of HH, and the glove and nail policies. Our second intervention was repeat HCW education. Our third intervention was immediate feedback (both negative and positive) to the HCWs by NICU head nurses. Individual surveys were conducted among the staff to assess the knowledge, perceptions, and barriers to HH. The outcome measure for this QI project was the HH compliance percentage. The process measures were the number of educational interventions for the first two PDSA cycles, and the number of times feedback given for the third cycle. The balancing measure was perceived increase in work burden. The data was plotted on a run chart (Figure 1) to interpret variations as random or non-random.

Results: We had a total of 377 observations at baseline, 319 for the first PDSA cycle, 239 for the second PDSA cycle and 298 for the third PDSA cycle. The baseline compliance was 31.56%. After the first intervention, HH compliance increased to 37.61%, and was 33.96% at the end of the second PDSA cycle. It increased to 46.64% after the third PDSA cycle.

Conclusion/Discussion: We were able to increase compliance with HH in our NICU by 15% after three PDSA cycles. Involvement of the unit leadership in the form of immediate feedback by NICU head nurses, brought positive results. Further cycles are in progress to reach the target of a 20% increase. Further stepwise interventions include putting up HH posters as reminders and giving individual rewards, to bring about a change in HH behavior. Appropriate interventions will also be planned to address the barriers noted on individual surveys, i.e, increased work burden (83.3%) and skin dryness and irritation (66.7%).