Targeted Interventions for Hand Hygiene Improvement in an Inpatient Pediatric Care Setting
Abstract
Introduction: In an effort to reduce healthcare associated infections (HAI), Children's Hospital of The King's Daughter's (CHKD) contracted a vendor in June 2023 to install a Bluetooth-enabled system of sensors throughout the hospital to monitor hand hygiene (HH) compliance. HH data from CHKD pediatric resident physicians and medical students from Eastern Virginia Medical School (EVMS) on clinical rotations were collected and analyzed weekly during June-July 2024, after which interventions to improve HH compliance rates were designed and implemented.
Methods: Pediatric residents and medical students on inpatient rotations were selected as subpopulations of the study due to their more widespread movement throughout the units and central workspace where interventions could be posted. Only data from CHKD inpatient wards were analyzed, as the HH tracking system is not installed in outpatient locations. Specific interventions included: weekly public posting of (1) individual user HH compliance data, (2) previous HAI data, (3) badge-wearing compliance differentiated into resident year groups and medical students, and (4) the reissue of new badges during the week of July 8th, 2024.
Results: Overall, each resident class and medical student body displayed fluctuations in hand hygiene compliance throughout the weeks. The average baseline compliance was 53% for the residents and 45% for the medical students. Maximum compliance was approximately 59% for the residents and 51% for the medical students. In terms of the global aim, HAI incidence reduced 25% in June 2024 as compared to May 2024 and changed 0% when compared to June 2023.
Conclusion: The data suggests none of the attempted interventions to date has had any lasting impact on compliance. Although HAI cases did decrease during the weeks of interventions, the lack of statistical significance makes it impossible to attribute a causal relationship between the two. One major limitation to the study is badge usage, particularly among the resident physicians. Usage steadily decreased over time to rates as low as <25%. Of note, the usage data for the medical students stayed high throughout the duration of the project and ranged from 73-100%. Further areas of study include interventions to improve badge usage.