Positive Reinforcement Drives Hand Hygiene Compliance

Jeanmarie Mayer, MD, from the University of Utah School of Medicine, and colleagues, report in the January 2011 issue of Infection Control and Hospital Epidemiology on their results from an interventional cohort study that used a behavioral change approach; they say it is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance.

In their quasi-experimental study from August 2000 to November 2001 and a descriptive time series from April 2003 to December 2006 in a 450-bed teaching hospital, Mayer et al. report that they introduced an initial intervention bundle in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. This bundle was disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives.

The researchers report that 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. They also report that the rate of compliance with hand hygiene significantly improved after the intervention in two cohorts over the first year (from 40 percent to 64 percent of opportunities and from 34 percent to 49 percent of opportunities. Mean compliance rates ranged from 19percent to 41percent of 4174 opportunities (at baseline), increased to the highest levels of 73 percent to 84 percent of 6,420 opportunities two years after hospital-wide dissemination, and remained improved at 59 percent to 81percent of 4,990 opportunities during year six of the program.

The researchers conclude that their creative campaign which used ongoing frequent audit and feedback with novel use of immediate positive reinforcement was implemented at an acceptable cost to the institution.

Reference: Mayer J, Mooney B, Gundlapalli A, Harbarth S, Stoddard GJ, Rubin MA, Eutropius L, Brinton B, Samore MH. Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement. Infect Control Hosp Epidemiol. Vol. 32, No. 1, January 2011.