Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance.

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The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital.This study was a time-series, quality-improvement project. Interventions were tested through multiple plan-do-study-act cycles on 2 pediatric inpatient units. HH compliance audits of HCWs on these units were performed randomly each week by the hospital infection prevention program. Control charts of percentages of HCW HH compliance were constructed with 3-σ (data within 3 SDs from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Charts were annotated with interventions including (1) increasing awareness, (2) providing timely feedback, (3) empowering patients and families to participate in mitigation, (4) providing focused education, and (5) developing interdisciplinary HH champions.HH compliance rates improved from an average of 87% (LOR 1) to ≥95% (LOR 2) within 9 months, and this improvement has been sustained for >2 years on both pediatric inpatient units.Significant and sustained gains in HH compliance rates of ≥95% (LOR 2) can be achieved by applying high-reliability human-factor interventions.





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McLean, Heather S, Charlene Carriker and William Clay Bordley (2017). Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance. Hospital pediatrics, 7(4). pp. 189–196. 10.1542/hpeds.2016-0110 Retrieved from

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Heather Seabury McLean

Professor of Pediatrics

My interests include quality improvement and patient safety, patient-family centered care, pediatric hospital medicine, and graduate and undergraduate medical education.  Through system change, I aim to improve the quality, value and safety of care of our patients at Duke Health.


William Clayton Bordley

Professor of Pediatrics

Dr. Bordley is an accomplished clinician educator and researcher. His clinical expertise is in pediatric emergency medicine and pediatric hospital medicine. He created and served as the Division Chief of Pediatric Emergency Medicine until 2021. Prior to this he organized and directed Duke's Pediatric Hospitalist program and Duke's Children's Procedural Sedation Unit. Academically his interests are focused on quality improvement, procedural sedation and bronchiolitis.

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