Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series

Background Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. Objective To improve healthcare workers' HH, and reduce healthcare-associated infections. Design 3-year interrupted time series with multiple sequential interventions and 1-year post-intervention follow-up. Setting Teaching hospital in rural New Hampshire. Interventions In five categories: (1) leadership/accountability; (2) measurement/feedback; (3) hand sanitiser availability; (4) education/training; and (5) marketing/communication. Measurement Monthly changes in observed HH compliance (%) and rates of healthcare-associated infection (including Staphylococcus aureus infections, Clostridium difficile infections and bloodstream infections) per 1000 inpatient days. The subset of S aureus infections attributable to the operating room served as a tracer condition. We used statistical process control charts to identify significant changes. Results HH compliance increased significantly from 41% to 87% (p