Infection Control Today -10/2003: Success Story

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Hand-to-Hand Combat:
The Creation and Implementation of a Hospital Hand-Hygiene Campaign

By Sheryl Ewert, Les Jebson and Nina Shik

Even before the Centers for Disease Control and Prevention (CDC) rolled out its revised hand hygiene guideline last October, members of a multi-disciplinary team at Kansas University Hospital, a 456-bed academic medical center, were putting their heads together. Their goal was to plan and implement a creative twist to combat a historical healthcare problem: noncompliance with hand-hygiene recommendations.

Data collected by infection control showed poor hand-hygiene rates. Motivated by this information, the infection control committee decided to take steps to increase healthcare worker compliance. Infection control teamed physicians and clinical staff with the hospitals marketing department to plan a clever internal effort to promote the use of alcohol-based handrub.


Essential to the campaigns success was capturing staff attention through the creative communication of CDC recommendations.

As soon as I approached our in-house marketing group about the campaign, I knew it would be a success, says Nina Shik, RN, MSN, CIC, infection control coordinator. Their enthusiasm sparked lots of ideas.

The next step was to present internal hand-hygiene rates, CDC recommendations, and campaign plans to key players, including hospital leadership and medical staff. In order to convince skeptics of the efficacy of alcohol handrubs, a microbiology experiment was done. One group of people washed their hands with antimicrobial soap and water, then had their hands cultured. A second group used an alcohol handrub and had their hands cultured. The results were convincing. Many colonies of bacteria were cultured from the soap and water group, but few from the alcohol group. Pictures of the agar plates were a dramatic part of the presentation.

Since studies show that although compliance rates increase following campaign initiatives, they often decrease shortly thereafter without continual reinforcement.1-2 Wanting to promote hand hygiene for the long-term, the planning team decided on a poster motif. Employees who exemplified good hand hygiene were photographed for the posters. Humorous phrases in English and Spanish were used to remind everyone about hand hygiene and the use of alcohol handrubs. A logo of a smiling hand with the message, Keep Em Clean was featured on the posters and lapel buttons.

Activities included exhibit tables by the hospital cafeteria, featuring quizzes about hand-hygiene trivia, with winners receiving prizes such as manicures, pedicures, gloves and mittens. Give-aways included alcohol handrubs, lotion, and lapel buttons. The weekly hospital newsletter featured front-page articles by the hospital CEO and chief of staff expressing the importance of hand hygiene. Posters were displayed hospital-wide and table tents in the cafeteria also raised awareness.

The cost of our hand-hygiene campaign was about $3,000, easily recouped if one nosocomial infection is prevented. When hand-hygiene compliance was measured two months after the campaign, compliance had increased overall by 20 percent. The use of alcohol handrubs had increased by 33 percent. The cost of handrubs is a minor expense, considering that healthcare-associated infections involve more than 2 million patients and cost the U.S. medical community over $4.5 billion annually.3

Every day, physicians, nurses, and ancillary staff enter and exit patient rooms, making critical judgments about patient care. One practice that is difficult to attain for a variety of reasons is consistent, effective hand hygiene. While hand-hygiene compliance remains an ongoing challenge, Kansas University Hospitals campaign is one approach to combat noncompliance and improve infection control practices.