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A real-time monitoring process improved hand hygiene compliance at Duke University Hospital, bringing its compliance rates to more than 90 percent -- far above the national average of 40 percent.

“Proper hand hygiene is a key component in providing patient care and preventing infections, but unfortunately it has not been a high priority historically,” said Deverick Anderson, MD, MPH, an infectious diseases specialist at Duke University Medical Center. “Nationally, the average for hand hygiene compliance is an abysmal 40 percent.”

Hand hygiene is a culture issue, according to Anderson. “Everyone knows it’s the right thing to do, but we have to make it a part of our culture and ensure that it happens every time a provider cares for a patient.”

In April 2009, Duke’s Infection Control and Epidemiology Department collaborated with Performance Services to develop a novel, tech-savvy method for increasing the presence of hand hygiene monitoring in the hospital and providing hospital leaders with data.

Nursing care assistants were hired to record hand hygiene compliance on an Enterprise Digital Assistant -- a hand-held, wireless device that relays messages in real-time to a Web site. The data are trended by month, unit, and the type of health care worker observed.

Duke University Hospital’s hand hygiene compliance increased to more than 97 percent after the program’s roll out and remains in the 90 percent range. The results were presented on a poster at the Fifth Decennial International Conference on Healthcare-Associated Infections on March 19 in Atlanta, Georgia.

“Prior to implementing the observation program we were only obtaining about 100 observations per month,” Anderson said. “We now have thousands of observations, and our data reflects the real-world situation as opposed to a small snapshot.”

Unit leaders in the hospital can access the reports anytime through the Web site and non-compliance is addressed immediately, followed by additional education.

“The unit-specific and health care worker specific data helps us target groups that need more training,” said Lisa Cooper, RN, an infection control nurse at Duke University Hospital.

The program’s success in improving hand hygiene at the hospital led to the recruitment of six full-time auditors who expanded the observations to Duke’s outpatient clinics and will be used throughout Duke University Health System in the future.

“I think we have a unique system that works really well,” Cooper said. “We will continue to improve and expand the program as well as find different ways to share the data and make people more cognitive of hand hygiene.”