Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives

Infect Control Hosp Epidemiol. 2013 Nov;34(11):1129-36. doi: 10.1086/673445. Epub 2013 Sep 23.


Objective: To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence.

Design: Time-series design with correlation analysis.

Setting: Tertiary care academic medical center, including outpatient clinics and procedural areas.

Participants: Medical center healthcare personnel.

Methods: A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection.

Results: A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase (P < .001) as well as from one phase to the next (P < .001), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios (R(@) = 0.70).

Conclusions: Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.

Publication types

  • Clinical Trial

MeSH terms

  • Academic Medical Centers / standards*
  • Employee Incentive Plans
  • Guideline Adherence*
  • Hand Hygiene / standards*
  • Health Personnel / economics
  • Health Personnel / organization & administration*
  • Humans
  • Leadership
  • Observation
  • Organizational Culture
  • Organizational Objectives
  • Practice Guidelines as Topic
  • Social Responsibility