Cleveland-based MetroHealth in 2010 launched Wash-In, Wash-Out, a program that has helped the system drastically increase hand hygiene compliance rates and slash three types of hospital-acquired infections.
Before launching the program, MetroHealth conducted
- an in-depth investigation of the care environment, the equipment used in care, and hand hygiene compliance rates, which stood at just 70 percent; and
- a thorough review of best practices by renowned organizations such as the World Health Organization (WHO), the Centers for Disease Control and Prevention, and The Joint Commission.
MetroHealth built the Wash-In, Wash-Out program around four teams, each of which is responsible for a different driver of hand hygiene compliance.
- An education team facilitates video-based and didactic education sessions, plans and coordinates training sessions, and analyzes workflows.
- A hand hygiene product assessment team ensures ideal placement and availability of soapless hand hygiene product and develops plans to install lotion dispensers.
- Just-in-time coaches monitor staff members to ensure compliance and provide feedback where appropriate.
- Infection prevention observers monitor hand hygiene on patient care units, analyze failures, and identify individuals who are resistant to coaching.
As a result of the initiative
- yearly central line-associated bloodstream infections (CLABSIs) in the intensive care unit fell from 40 in 2010 to 25 in 2012;
- ventilator-associated pneumonia cases dropped from 51 in 2011 to 34 in 2012;
- catheter-associated urinary tract infections (CAUTIs) fell from 119 in 2011 to 76 in 2012;
- hand hygiene compliance rates stayed between 97 and 99 percent in 2011 and 2012; and
- MetroHealth estimates it saved more than $1 million per year after an initial investment of $50,000.
To sustain this success, MetroHealth launched a communications campaign that included
- buttons, table tents, and hallway signage;
- process and outcome data shared biweekly with all staff; and
- strong executive sponsorship from the CEO, chief operating officer, chief medical officer, and chief nursing officer.