While hand hygiene (HH) rates have been consistently linked to patient safety and controlling rates of nosocomial infection, traditional, direct observation methods of measuring HH are highly subject to the Hawthorne effect, and even with extensive auditing programs, they can only capture a fraction of HH opportunities. With hundreds of hours of observation, an algorithm was developed to capture how many possible moments of HH occurred on an inpatient unit, based on Public Health Ontario’s four moments of HH, during regular patient care. The average number of HH events per hour was determined, and an electronic monitoring system that captured each time a soap or alcohol based hand rub (ABHR) dispenser was used to record actual HH events. This system communicates with the hospital bed management system to receive real time updates on how many patients comprised the unit census at any given time, enabling a denominator to be collected to determine a much more accurate estimate of HH compliance on a unit. Once this validation was complete, rates as measured by electronic monitoring were released to unit staff and targeted interventions took place on a weekly basis, in collaboration with Infection Control department to improve HH compliance. Spearheaded by Sunnybrook, this quality improvement intervention fuelled by more accurate measurement of HH compliance was introduced across four other Ontario hospitals known as the HH-IMPACT (HH-Improvement to Prevent and Control Transmission) network. This collaborative met weekly to facilitate sharing of ideas to improve HH rates and enhance patient safety across institutions.

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