Continuous Hand Hygiene Monitoring Associated with a Two-Year Elimination of Central Line Associated Bloodstream Infections in the NICU

Hand Hygiene (HH) is the single most important method of preventing Central Line-Associated Bloodstream Infections (CLABSIs). We conducted a continuous 15 months long Performance Improvement project of HH monitoring in the NICU. Overt audit was conducted by trained unit staff, using modified World Health Organization Hand Hygiene Observation Tool. The data collected from October 2015 to December 2016 was entered into a departmental database. Of a total of 1466 observation, HH was observed 591, 40.3% times in nurses, 335, 22.9% times in resident and attending physicians, 148, 10.1% in Respiratory Therapists, and 392, 26.7% times in other ancillary staff. Most observations were conducted during the 0800-1600day shift (768, 52.4%), followed by the 1600-0000 evening shift (358, 24.4%), and then by the 0000-0800night shift (340, 23.2%). HH before touching patient was observed most commonly. Overall HH compliance rate increased from the pre-project nadir of 63% to 99.9% during the project period. Only 4 fallouts were identified, all during the day shift. Of these, 3 fallouts were observed in nurses, and 1 in a resident physician. In each instance education was provided in real-time. The interim analysis was shared at monthly unit staff meetings. After the PI project was completed, HH was observed by Head/Charge Nurses and Infection control personnel. From January 2017 to January 2018 HH compliance rate in NICU remained at 100%. There were no CLABSI events for a total of 27 months. Our experience is consistent with previous reports suggesting that education and feedback are the most successful strategies in achieving high HH compliance. We believe that combining real time education with feedback is as important as routine sharing of performance indicators with the multidisciplinary unit team. A positive after-effect in the post PI project phase demonstrates a change in the safety culture of our NICU.