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Reduce Infections, Save Money with Hand Hygiene

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.

  1. An education team facilitates video-based and didactic education sessions, plans and coordinates training sessions, and analyzes workflows.
  2. A hand hygiene product assessment team ensures ideal placement and availability of soapless hand hygiene product and develops plans to install lotion dispensers.
  3. Just-in-time coaches monitor staff members to ensure compliance and provide feedback where appropriate.
  4. 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.


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