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8 day with the results of the observations. Staff members that don't comply are reminded and coached on proper hand hygiene techniques. Since implement- ing the program, UCSF's compliance rates have hovered around 90 percent ev- ery month, up from 75 percent when it started. In September of this year, com- pliance was at 94 percent. The rate of HAIs at UCSF has declined because of the hand hygiene program, including a drop in central line-associated bloodstream infections. In July, California U.S. Senator Barbara Boxer visited UCSF Medical Center to thank the staff for taking steps to save patients' lives. In an a recent observational study published in Infection Control and Hospi- tal Epidemiology, researchers at the University of Iowa Hospital Clinics in Iowa City found that hospital workers demonstrated higher rates of hand hy- giene compliance when other healthcare workers were present. Researchers deployed a custom-built, automated hand hygiene monitoring system that served two purposes: detecting if a worker performed hand hygiene upon entering and exiting a patient's room and estimating the location of other healthcare workers with respect to the worker under observation. Over a 10-day period, a total of 47,694 hand hygiene opportunities were identified. When a worker was alone, adherence rates were just under 21 percent. When other healthcare workers were present, hand hygiene adherence increased to just under 28 percent. Additionally, observed hand hygiene compliance in- creased when more coworkers were present. The goal of Chapel Hill-based UNC Health Care's hand hygiene program is to help all UNC hospitals achieve at least a 90 percent compliance rate. Even though hospitals in the UNC system have been performing at an 80 to 90 percent compliance rate for the past several years, The Joint Commission requires healthcare facilities to show continuous improvement. To meet that goal, UNC recently launched the hand hygiene program called "Clean In, Clean Out." The initiative requires all UNC hospital employees, including nurses, physicians and support services, to wash their hands every time they enter and exit a patient's room. To measure compliance, employees observe one another and report on their findings, the results of which are updated monthly on an online database and made available collectively, as a hos- pital, by individual unit and by occupational group. Observations are also recorded using paper forms and using the mobile app called iScrub. When non-compliance occurs, scripting and non-verbal reminders are given. On the other hand, rewards and incentives are given to employees with the most observations and to hospital locations and occupation groups with the high- est compliance rates. The measurement period for fiscal year 2015 began on Oct. 1, 2014, and ends on May 31, 2015. UPMC Presbyterian Hospital in Pittsburgh has increased clinical staff hand washing and sanitizing compliance to nearly 100 percent through education and accountability measures. The initiative, called Just Culture at UPMC Presbyterian, was implemented June 2012. The program includes education, videos, internal newsletter articles, posters and verbal reminders about hand hygiene. Through the program, healthcare personnel are held accountable for disregard of patient safety, including hand hygiene. Staff who don't wash their hands are warned and then progress through a structure of disciplinary actions if they continue to disregard hand hygiene. Within four months of launching the Just Culture initiative, hand hygiene compliance at the hos- pital improved from 70 percent to 99 percent. The hospital has maintained the high compliance rate through re-education and an overall cultural shift toward accountability. At the University of Utah Hospital, located in Salt Lake City, the mean hand hygiene compliance rate among all healthcare workers improved from 19 percent to 81 percent from 2000-2006, according to a 2014 report published in JSTOR by the Infection Control and Hospital Epidemiology group. Hand hygiene adherence was measured in 12 patient care units, including six acute- care units (322 beds), one oncology unit (25 beds) and five intensive care units (103 beds) among nurses, physicians and other healthcare staff. The hospital employed two behavioral interventions in an effort to improve hand hygiene: an initial intervention that addressed cognitive and behavioral fac- tors that influenced hand hygiene, such as providing educational presenta- tions about hand hygiene and one-on-one discussions with clinical staff and infection control personnel, and a second, hospital-wide intervention that aimed to modify behavior through positive reinforcement, such as handing out chocolate to healthcare workers "caught in the act" performing hand hy- giene. The study also found that healthcare workers rapidly accepted alcohol sanitizers in place of soap and water, with the use of sanitizer accounting for an increasing proportion of overall hand hygiene actions. Vanderbilt University Medical Center in Nashville, Tenn. improved hand washing rates among faculty and staff members nearly 40 percent over a five- year span. As of May 2014, handwashing compliance was at 97 percent, up from 58 percent in 2009. After Gerald Hickson, MD — VUMC's senior vice president of quality, safety and risk prevention and assistant vice chancel- lor for health affairs — witnessed multiple VUMC employees fail to wash their hands when caring for his wife, post-operation, he took immediate ac- tion. Together, Dr. Hickson and VUMC's chief epidemiologist Tom Talbot installed additional hand sanitizer and lotion dispensers, designated one per- son in each department to observe and report on handwashing habits in their unit and offered financial incentives to units whose hand hygiene habits met standards. Since VUMC implemented the innovative program, many HAIs have declined considerably, including bloodstream infections associated with central lines, which decreased by 80 percent. Wake Forest University Baptist Medical Center in Winston-Salem, N.C., also monitored hand hygiene compliance as part of the Joint Commission Center for Transforming Healthcare Project, beginning in 2008. WFUBMC imple- mented use of an electronic method to monitor and increase compliance for hand hygiene. The real time location system used radiofrequency identification to monitor hand hygiene compliance by tracking and recording the approach of employees wearing special electronic tags on their I.D. badges. The RTLS technology also allowed for just-in-time alerts to healthcare workers as they approach the patient-care threshold as a reminder to wash their hands. The medical center also implemented a regular schedule for refilling sanitizer dis- pensers and worked with dietary, radiology, phlebotomy and other unit floors to improve compliance. For five months out of a six-month period during the program, WFUBMC had no instances of HAIs. n SIGN UP TODAY! Infection Control & Clinical Quality Becker's Infection Control & Clinical Quality E-Weekly www.beckersinfectioncontrol.com or call (800) 417-2035