Hand hygiene is the single most effective way to prevent the spread of infection. Compliance has been anything but stellar. Basis of education and campaigning for proper hand hygiene compliance should be based on key behaviors that are not followed. A combination of monitoring nursing staffs’ behaviors of noncompliance and education programs based on these behaviors may aid better compliance rates.

   Numerous studies have been conducted looking at compliance rates in various hospital settings. These studies have revealed that compliance is usually estimated as less than fifty percent (Pittet, 2001). Other studies have examined several barriers that have also impacted hand hygiene compliance. The introduction of alcohol hand gels, increased access to automated sinks, and motion- sensed towel dispensers have made hand hygiene more convenient, faster and aided in eliminating some barriers but compliance still remains low.  Promotion of hand hygiene remains a challenge among infection control experts. 

Infection control specialists, intensive care physicians and hospital administrators have been working diligently in instituting different protocols to prevent and treat infection early to prevent complications. Presently, in the United States, nosocomial infections complicate eight to twelve out of one hundred hospital admissions, costing 4.5 billion dollars and account for 90,000 deaths per year (http://www.handhygiene.org, 2006).  

     The Institute for Healthcare Improvement (IHI) recommends interventions or “bundles” to help decrease the risk of nosocomial infections in the intensive care units. These bundles are defined as evidence-based practices that have shown to reduce the incidence of nosocomial infections in the intensive care population. Currently, there are many bundles utilized by different facilities to guide practice. PENN Presbyterian Medical Center is presently focusing on three. They are: Blood Stream Infection Bundle (BSI), the Ventilator-Acquired Pneumonia Bundle (VAP) and the Foley-Related Urinary Tract Infection Bundle. All three bundles have specific guidelines to help prevent nosocomial infections including hand hygiene as the first and most important intervention on two of the bundles (http://www.ihi.org).  

     The infection control specialists, along with the clinical nurse specialists in both intensive care units at PENN Presbyterian have tracked compliance with these bundles through observation since January 2006 in the two intensive care units. The compliance rate for all aspects of the bundles has been eighty-eight to one hundred percent except for hand hygiene, which has been between forty-seven to sixty percent, right on target with the national average. This surveillance prompted the need for a more focused observation and a promotion campaign to help increase compliance and change the behaviors and cultures in both units. Since March of 2006, a monitoring tool based on the CDC guidelines has been utilized to track behavior. Intensive education and campaigning for Hand Hygiene has been done for all nursing staff in the CCU and ICU at PENN Presbyterian Center. Nursing compliance for hand hygiene has improved tremendously from 47-60% to 81.3-96.6%. Currently nurses, clinical educators and infection control specialists are working with other disciplines in order to improve their hand hygiene compliance throughout entire hospital.