Interdisciplinary Hand Hygiene Bundle Intervention with Medical Student-Led Curriculum to Improve Staff Compliance and Engagement

From the 2019 HVPAA National Conference

Ms. Oge Onuh (Icahn School of Medicine at Mount Sinai), Mr. Kevin Cheung (Icahn School of Medicine at Mount Sinai), Dr. Mona Krouss (Icahn School of Medicine at Mount Sinai), Ms. Nicole Wells (Icahn School of Medicine at Mount Sinai), Ms. Tamara Solly (Icahn School of Medicine at Mount Sinai), Dr. Tuyet-Trinh Truong (Icahn School of Medicine at Mount Sinai)

Objective

Promote hand hygiene culture and improve compliance rates on two hospital medicine units at Mount Sinai Hospital through student-led interactive training with staff as part of an interdisciplinary bundle intervention.

Background

Hand hygiene contributes significantly to combating hospital-acquired infections (HAIs) and their estimated annual economic burden of $35.7 billion to $45 billion in the U.S for in-patient hospital costs. Efforts to improve hand hygiene compliance are important for patient safety, and there is a need to develop innovative and customized strategies for improvement.

Methods

An interdisciplinary bundle intervention for hand hygiene improvement was formed as a hospital wide initiative. The bundle included a new “Close Attention to Clean Hands” (CATCH) campaign, new posters on hospital units, and a staff-produced “I Promise” video campaign, spearheaded by a range of hospital staff. The medical student component comprised of a three-session, medical student-led, interactive curriculum for unit staff. The top three reasons for non-compliance for both units were identified from routinely collected unit-level observations of compliance. The sessions aimed to identify the barriers to compliance, brainstorm reason-specific strategies to improve practices, and use role-play scenarios to practice holding fellow colleagues accountable. Unit hand hygiene compliance rates were tracked monthly, and a post-intervention feedback survey on the curriculum was distributed to participating staff.

Results

The hand hygiene initiatives improved compliance rates on both units. The average compliance rates in the 3 months prior to intervention (October 2018 to December 2018) were 84.3% and 87.6%. The year-to-date compliance rates (January 2019 to March 2019) increased to 99% and 97.6%, respectively. Preliminary data from post-intervention surveys (n=9) showed positive staff perceptions. On a 5-point Likert scale, staff reported increased comfort in approaching non-compliant colleagues (M=4.11), improved hand hygiene culture and awareness (M=4.22), increased self-awareness of hand hygiene practices (M=4.33), finding the role-play scenario sessions helpful (M=4.44), finding new posters helpful (M=4.44), feeling like they had learned something new (M=3.88), and believing that similar sessions should be implemented on other hospital units (M=4.44).

Conclusions

Through a bundled intervention featuring collaboration between medical students, administration, and nursing and PCA staff, both units saw an improvement in hand hygiene compliance and engagement. Preliminary survey results from participating staff suggest the feasibility of student-led initiatives and interdisciplinary bundles as an acceptable strategy to improve hand hygiene culture. Our project was limited by several factors. We were unable to ensure the same cohort of participants during each session, not all participants attended all three sessions, and compliance rates are measured through covert observations that do not ensure full accuracy.

Clinical Implications

Hand hygiene remains a mainstay strategy to protect patients from the risks of hospital-acquired infections. Interdisciplinary collaboration among students, staff, and administration, for instance through medical student-driven initiatives, is a creative and positive model of hand hygiene promotion. By enhancing engagement, we can create a more sustainable and longitudinal culture of patient safety and quality of care.

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