1. Allen, Marianne MN, RNC
  2. Clement, Mary Ann MSN, RN, CRNR
  3. Fowler, Kimberly A. MSN, RN
  4. Harne-Britner, Sarah MSN, RN, CCRN

Article Content


Describe a collaborative research study examining the effects of staff education and behavioral interventions on hand hygiene adherence and unit-acquired infection rates.



Clinical Nurse Specialists are responsible for promoting patient safety across the health system. Hand hygiene is the simplest, most effective way to prevent nosocomial infections (Pittet, 2001) and has been identified as a Patient Safety Goal for JCAHO. Previous studies have reported hand hygiene adherence rates varying from 20% to 80% among healthcare workers (Larson et al, 2000).



Clinical Nurse Specialists collaborated with nursing faculty, staff nurses, and nursing students to design the study. A quasi-experimental design examined the effects of education paired with 2 types of behavioral interventions on hand hygiene adherence.



Three medical-surgical units participated in the study. One control group and 2 experimental groups were randomly selected. The CNS facilitated baseline and ongoing collection of hand hygiene observations using the Hand Hygiene Assessment Tool (KR = 0.94). Each group completed a self-study hand hygiene educational module. Experimental group 1 received behavioral interventions of individual/group rewards for improved adherence. Experimental group 2 received a behavioral intervention focusing on the risks of nonadherence with hand hygiene. Hand hygiene adherence and infection rates were monitored for 6 months following the interventions.



A total of 1,203 hand hygiene observations were analyzed using a Z-test. Experimental Group 1 had significant change in hand hygiene adherence after education (P =.01) and sustained improvement in hand hygiene adherence over 6 months compared with control group (P =.03). The Control Group and Experimental Group 2 showed no statistically significant changes in hand hygiene adherence over 6 months. No correlation was identified between unit-acquired infection rates and hand hygiene adherence.



Education paired with positive reinforcement improves hand hygiene adherence and impacts clinical practice. The study limitations included nonequivalent study units, higher baseline adherence in control unit, and a nonconcealed observation method.


Implications for Practice:

Clinical Nurse Specialists are collaborating with the Manager of Accreditation to implement system-wide education and positive reinforcement strategies to improve hand hygiene adherence.