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By most accounts, approximately 1.7 million patients will develop a hospital-acquired infection this year. An estimated 90,000 patients will die of infection they acquire while hospitalized. Beyond the cost in human life, the average patient infection costs the hospital somewhere between $25,000 and $100,000 (estimates vary greatly). In the November/December 2006 issue of the American Journal of Medical Quality, it was estimated that the elimination of a single bloodstream infection case would pay for nearly a year’s worth of measures to stop infections within a hospital.

In January 2008, Tufts Medical Center was facing the reality its own less-than-satisfactory hand hygiene compliance rate of 71%. The obvious risks to patient safety, along with an impending visit by the Joint Commission, led Tufts to launch a comprehensive hand hygiene program in March 2008. This was not the first time that Tufts Medical Center had traveled this path, but it was with a new level of commitment and creativity. And the dedication paid off.  By the end of the campaign’s first month within the medical center, Tufts’ compliance had increased to 90%. By August 2008, the compliance rate had improved to 99% with 7 units scoring a perfect 100%. During the Joint Commission’s intensive 5-day visit to Tufts in September, they did not find a single hand hygiene violation.

The Tufts Hand Hygiene campaign led to dramatic results, introducing novel messaging and signage, while integrating many of the best practices in the industry. Based on the Tufts experience, we’ve compiled a list of many of the components necessary to increasing hand hygiene compliance and reducing the number of hospital-acquired infections:

• Employees must be educated about the relation between proper hand hygiene and patient safety.

• The easier the access to sinks and alcohol gel dispensers, the better the compliance.

• It is important to create a culture of patient safety, where colleagues feel comfortable reminding one another to practice proper hand hygiene.

• It is vital to create an environment where patients and families are educated about the importance of proper hand hygiene, and are given permission to ask their care providers to comply.

• Accountability only comes into play if compliance is being measured and results are being shared.

• An administrator can be the standard bearer for the campaign, but it will only succeed if there are champions in the units. Try appointing a task force made up of individuals who can champion the effort at the department or unit level.

• The campaign must be graphically distinct to capture the attention of healthcare providers, patients, and families. Avoid letting the campaign become part of the background, and make sure it’s refreshed periodically.

• Positive reinforcement is ideal. Recognize and reward units who raise their compliance numbers.

• Make the program ubiquitous. Profile the campaign in internal publications; give presentations at department heads meetings; send out email blasts to employees; and even consider sending a letter to the home of each staff member.

• Hold launch events, allowing employees from all shifts to be a part of the kick-off. You can also plan events around National Handwashing Awareness Week and National Patient Safety Week to reinvigorate your campaign.

Ultimately, you are working to change years of bad habits. By sustaining the effort over time, your employees will come to see that this is not another fleeting initiative, but rather as a permanent commitment to patient safety on the part of your organization, its employees and leadership. Only then will your culture begin to change.

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