A hand hygiene intervention that used positive deviance — learning successful strategies from people in the community — increased hand hygiene compliance by a third, which was associated with a 43.2 percent decrease in the incidence of medical device-associated infections per 1,000 patient-days, according to a study in the American Journal of Infection Control.
A positive deviance intervention was implemented in six Brazilian hospitals and one Thai university hospital from November 2011 to July 2012. The intervention defined hand hygiene positive deviants as healthcare workers who wanted to change behavior and develop innovative ways to improve hand hygiene compliance, and who motivated others to perform hand hygiene.
The PDs met with all healthcare workers twice each month to discuss areas for improvement and to recognize examples of good hand hygiene. The PDs also met among themselves to discuss strategies to improve compliance. These strategies, which differed at each hospital, included moving the location of alcohol gel dispensers, changing the pressure of the tap water and training all staff.
Hand hygiene compliance increased from 46.5 percent before the intervention to 62 percent after, an increase of 33.3 percent. The incidence of device-associated infections per 1,000 patient-days decreased 43.2 percent, from 13.2 to 7.5 and the median length of stay decreased from 11 to 6.8 days.
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