Comprehensive survey of hand hygiene measurement and improvement practices in the Veterans Health Administration

Background Veterans Health Administration (VHA) is a national health care system with variation in hand hygiene (HH) measurement and improvement practices across its facilities. The objective of this national survey was to characterize this variability and identify opportunities for standardization. Methods Survey covered 3 major areas of HH: (1) methods of measuring HH compliance, (2) interventions to improve HH compliance, and (3) site-specific targets for HH compliance. Results One hundred forty-one (100%) VHA medical centers returned the survey. A majority (98.6%) of the medical centers conduct direct observations to measure HH compliance rates. Fewer than half (45.3%) validate the observer process at the onset, and fewer still (39.6%) continue to validate observers. Main behaviors that are considered HH opportunities are room entry (69.1%) and exit (71.9%). Improvement interventions include posters (97.2%), feedback (eg, 98.6% to leadership), and improved access to HH products (eg, 90.6% provide individual hand sanitizers to staff). Mandatory education programs for clinical staff are conducted in 88.5% of the medical centers. The majority of the medical centers (77.3%) set their HH compliance target over 90%. Conclusion Although HH improvement interventions are relatively similar across VHA medical centers, variation exists in compliance monitoring. Findings will assist in standardizing surveillance and next steps in hand hygiene policy in VHA.