1. Hand Hygiene Compliance Program Overview FY14 Quality Goal

2. Importance of Hand Hygiene Healthcare-associated infections (HAIs)-1.7 million cases per year (U.S.); 98,000 deaths per year $>10 billion per year (U.S.) Fraction of HAIs that are preventable with changes in hand hygiene practices not known – 38% due to cross-transmission – Increase in hand washing, reduction in HAIs

3. ASSOCIATION BETWEEN HAND HYGIENE COMPLIANCE AND HAI RATES Author, yearSettingResults Casewell, 1977Adult ICUReduction HAI due to Klebsiella Maki, 1982Adult ICUReduction HAI rates Massanari, 1984Adult ICUReduction HAI rates Kohen, 1990Adult ICUTrend to improvement Doebbeling, 1992Adult ICUDifferent rates of HAI between 2 agents Webster, 1994NICUElimination of MRSA* Zafar, 1995NewbornElimination of MRSA* Larson, 2000MICU/NICU85% reduction VRE Pittet, 2000HospitalwideReduction HAI & MRSA cross-transmission HAI, healthcare-associated infections *Other infection control measures also instituted Boyce JM, Pitter D. MMWR 2002;51(RR-16)

4. Intervention: Improved hand hygiene, oral care, central line care Outcomes: (compared to baseline period) Reduced HAI (Odds Ratio: 0.37 VAP, 0.42 CLABSI) 2.3 fewer days in hospitals per patient $12,000 less hospitalization costs per patient 2.3 percentage points lower for mortality

5. Indications for Hand Hygiene BEFORE  Direct patient contact (with or without gloves)  Putting on sterile gloves  Inserting a device  Eating and drinking AFTER  Direct patient contact  Removing gloves  Contact with the patient’s environment  Contact with body fluids, wound dressings  Moving from a contaminated body site to a clean site

6. What is the Track Record on Handwashing in Healthcare Facilities? A review of 34 published studies of handwashing adherence among healthcare workers found that adherence rates varied from 5% to 81% The average adherence rate was only 40% Average Handwashing Adherence of Pers o nnel in 34 Studies Average

7. Rationale for Program UNC hand hygiene compliance static at 80-90% over last several years Compliance historically measured only by Infection Prevention staff and Infection Control Liaisons Joint Commission requirement to show improvement PICU demonstrated success with frontline staff conducting observations and providing immediate feedback

8. Hand Hygiene Program Overview 90% housewide compliance (inpatient areas) – October 1-May 31 (measurement period) – July 1-September 30 (baseline/intervention development period) Clean In/Clean Out Observations by – iScrub App for Apple products – Paper forms entered in web-based survey tool

9. Hand Hygiene Program Overview All employees who enter patients’ rooms will – Be eligible to be observed – Be asked to provide observations Suggested set of 5 every month by each employee Minimum of 50 for an inpatient unit in a month Compliance data reporting – Paper graph on each unit where observers can chart % – Monthly reports – hospital wide by location and group

10. Hand Hygiene Program Overview Immediate feedback component – Scripting and non-verbal reminders provided Rewards/Incentives – Employees with most observations – Departments with most unique observers – Highest compliance by location, occupational group Hospital leadership involvement – Signed letters of support – Observations on leadership rounding