RT Journal Article
T1 "The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology.
A1 Mestre, Gabriel
A1 Berbel, Cristina
A1 Tortajada, Purificación
A1 Alarcia, Margarita
A1 Coca, Roser
A1 Gallemi, Gema
A1 Garcia, Irene
A1 Fernández, Mari Mar
A1 Aguilar, Mari Carmen
A1 Martínez, José Antonio
A1 Rodríguez-Baño, Jesús
K1 Infecciones
K1 Mano
K1 epidemiología
K1 Control de Infecciones
K1 Enfermería
AB BACKGROUNDOnly multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance.METHODOLOGY/PRINCIPAL FINDINGSPre-post intervention study of HH performance at baseline (October 2007-December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: "3/3 strategy"); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2-80.7) vs 84.6% (95% CI:83.8-85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time ("positive": 90.1% as highest HH compliance coinciding with the "World hygiene day"; and "negative":73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding).CONCLUSIONS/SIGNIFICANCECQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers.
PB Public Library of Science
YR 2012
FD 2012-10-22
LK http://hdl.handle.net/10668/937
UL http://hdl.handle.net/10668/937
LA en
NO Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi G, et al. "The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. 2012 PLoS ONE; 7(10):e47200
NO Journal Article; Research Support, Non-U.S. Gov't;
DS RISalud
RD Apr 18, 2025