"I took a pledge": Using role modeling and team accountability to create a culture of heightened awareness around hand hygiene
Hand hygiene is considered the most important strategy in preventing healthcare acquired infections (HCAIs). In recent years, the Ministry of Health and Long Term Care (MOHLTC) and University Health Network (UHN) have committed to improving hand hygiene by increasing access to hand rubs and publicly reporting hand hygiene compliance. However, frontline health care workers on General Internal Medicine (GIM) at Toronto General Hospital (TGH) unanimously state that there is room for improvement. Our discussions highlighted certain barriers to hand washing, which include: physical obstacles blocking pumps, visibility of pumps, lack of reminders and championing from peers.
Due to a lack of evidence and randomized control trials, the best interventions for improving hand hygiene compliance have not yet been identified. The "I took a Pledge." project is a multimodal intervention, currently being piloted on GIM at TGH. It aims to increase hand hygiene compliance through role modeling and increased team accountability. Strategies include: asking workers to sign a pledge that states, "I Pledge to Wash my Hands"; displaying this pledge at ward entrances; and recognizing individuals who have taken the pledge through badge insignia, which are coloured by team. Other initiatives include: increasing awareness through videos and vibrant signage reminding people of our cause; and reporting each team's hand hygiene compliance rate by week. Future steps include: obtaining feedback from healthcare workers about the utility of our interventions, and considering the use of scrub wear to further heighten GIM providers' awareness of best hand hygiene practices.