QualPro Helps Improve Hygiene and Save Lives
A note on the white boards in hospital patients’ rooms
saying, “I like clean hands,” can result in higher rates of
hand-washing among health professionals, but a sign in
the staff lounge urging hand-hygiene compliance prob-
ably will not make a difference.
These are among the findings of a rapid intervention-
testing process used at seven hospitals in the Sentara
Healthcare system, headquartered in Norfolk, Va., that
pushed the hand-hygiene compliance rate to 92.5%. The
nationwide hand-washing rate has hovered around 50%,
depending on the study and measurement used.
Like many health systems, Sentara finds itself under
pressure to improve hand-hygiene compliance rates that
have been linked to nosocomial infections. Rates of
such infections are being publicly reported, and many
insurers withhold payment for treating some infections
acquired in the hospital.
Sentara already had easily accessible sinks and sani-
tizer foam, yet a revised audit process had shown its
compliance rate at about 75%. Officials had thought the
rate was closer to 95%.
The auditing was previously done by health profes-
sionals who may have overestimated the amount of
hand-washing occurring because they monitored their
own hospital area while completing other job duties.
The revised system sent health professionals to monitor
other work areas and focus on monitoring hand-hygiene
compliance.
“Hand hygiene has the most linear connection there is
between a process and patient safety,” said Gene Burke,
MD, Sentara’s executive medical director. “This is like
apple pie and motherhood."
Patient room notes, pop quizzes boost hand hygiene
Rapid testing of interventions help a health system figure out how to remind doctors, nurses and other
health professionals to wash up.
By Kevin B. O’Reilly, amednews staff. Posted Feb. 29, 2012.
American Medical News
Published by the American Medical Association
Last summer, Sentara gathered 83 health profession-
als from its hospitals to brainstorm fast and cheap ideas
that might help drive up hand-hygiene rates. The system
hired QualPro, a Knoxville, Tenn.-based consulting
firm, to help test and analyze 21 interventions in 48
nursing units.
Interventions tested included computer screen sav-
ers encouraging hand hygiene and Hero of the Month
awards to people who achieved high compliance rates.
Different combinations of interventions were tested
over six weeks in different units to provide a kind of
rolling controlled trial.
Pop quizzes help hygiene
A second round of testing was done in 32 nursing
units with the interventions that had proved the most
effective. In addition to the white-board notes, putting
up red stop signs to remind physicians and other health
professionals to clean their hands was helpful. Another
method that worked was giving a written hand-hygiene
quiz to any health professional randomly stopped by a
department leader or other executive.
“Everybody was fair game for these quizzes,” Dr.
Burke said. “If you were physically in the unit -- if you
were someone who could transfer bacteria or a virus
-- you were a target. ... You can’t do this stuff with only
nurses.”
Interventions that work can vary by unit or by hospi-
tal, Dr. Burke said. Just because pop quizzes worked at
Sentara does not mean they will be especially helpful in
other systems.
“You can’t make extrapolations,” he said. “What has
worked in our culture wouldn’t necessarily transfer
somewhere else.”