Achieving sustained improvement in hospital hygienic cleaning using peer-group benchmarking

Abstract number: O468

Carling P., Dick B., Eck E.

Objectives: Ongoing contamination of surfaces in the "patient zone" (Pittet 2007) has become increasingly recognized as playing a role in the transmission of major healthcare-associated pathogens. Over the past five years an indirect monitoring system has been used to improve environmental hygiene related to discharge cleaning in almost 100 hospitals. In view of these results, we undertook a prospective evaluation of a multi-hospital benchmarking program to further analyze this approach for improving the thoroughness of disinfection cleaning (TDC) at discharge.

Methods: The TDC of fourteen high touch objects was evaluated using a fluorescent dye based targeting method in two hospital systems consisting of 12 hospitals (Group A) and 7 hospitals (Group B) administratively related within each group but geographically and functionally independent institutions. A three phase intervention was utilized as previously described (ICHE 2008; 29: 1035–41). TDC scores were provided to the environmental services administration at each hospital and on a regular basis as part of system-wide quality assurance reviews for each system. At each meeting TDC scores were reviewed and the most effective programmatic and educational interventions shared.

Results: As noted in the Figure, pre-intervention (Phase I) TDC scores averaged 39% (95% CI 27.4 to 50.1) in group A hospitals and 53% (95% CI 33.1 to 72.8) in group B hospitals. Following education alone (Phase II), scores in both hospital groups improved with group A hospitals improving to 70.1% and group B hospitals to 68%. Subsequently (Phase III) and as a result of serial feedback and peer group benchmarking (F/Us), overall TDC continued to improve in group A hospitals to 88% and group B hospitals to 77%. As noted in theFigure, high levels of improvement were documented for sustained periods of time (to date, 6 to 16 months).

Conclusions: (1) Phase I of the study disclosed previously unsuspected differences in TDC despite the existence of similar cleaning policies in all hospitals. (2) Group benchmarking of TDC scores favorably impacted additional improvement in cleaning. (3) The ongoing transparency engendered by the system-wide programs has made it possible to sustain gains for up to 18 months. (4) The development of a patient-safety oriented, non-punitive environment as well as individual hospital and system-wide leadership support were recognized as critical components of the success of the program.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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