Proper hand hygiene has long been a top patient safety priority at the MGH, with study after study demonstrating that healthcare-associated infections– which can lead to longer hospital stays, complications and even death – may be spread from one patient to another via the hands of health care workers. According to the CDC, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year in the United States alone. The use of alcohol-based hand rubs before and after contact with every patient greatly reduces the spread of these infections.
The MGH has taken a multifaceted approach to improving the hand hygiene practices of its health care workers. A group called the STOP (Stop the Transmission of Pathogens) Task Force, with representatives from all major care groups, was created to address the issue. A comprehensive communications and educational campaign promoting proper hand hygiene technique was launched across the institution. A number of MGH employees were designated as hand hygiene “champions,” leaders that encourage compliance and educate their peers on proper technique. Alcohol-based hand rub dispensers also were placed in additional places across the hospital, making it easy for staff to practice proper hand hygiene. In 2007, a modest hospital-wide bonus was awarded when the hospital had achieved TJC targets.
Since the inception of this new approach in 2002, hand hygiene compliance rates at MGH have increased from 8% to 93% “before contact” with the patient or patient’s environment, and from 47% to 94% “after contact.” These rates are better than the 90% compliance expectations set by the Joint Commission. Some inpatient units have achieved the hospital’s ultimate goal of 100%. In addition, as its hand hygiene practices and compliance improved, MGH observed a significant and sustained decrease in its rates for healthcare-associated cases of methicillin-resistant Staphylococcus aureus (MRSA). That rate was cut in half, despite a two-fold increase in the number of patients who arrive at MGH with MRSA infection. Steady progress has been made over the years, and the hand hygiene program has become one of the MGH’s most successful initiatives in improving patient safety. In fact, the program has recently garnered external recognition as one of the recipients of the 2007 Betsy Lehman Patient Safety Recognition Award, which is presented by the Massachusetts Betsy Lehman Center for Patient Safety and Medical Error Reduction. Our challenge now is to sustain those gains and push on to achieve an even higher level of compliance.