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Resident-Driven Quality Improvement Project in Perioperative Hand Hygiene

Pimentel, Marc Philip T. MD, MPH*; Feng, Aiden Yuzhe MD, MBA*; Piszcz, Regina MBA; Urman, Richard D. MD, MBA*; Lekowski, Robert W. Jr MD, MPH*; Nascimben, Luigino MD, PhD*

doi: 10.1097/PTS.0000000000000282
Original Article: PDF Only

Objectives The goal of the project was to improve hand hygiene compliance in the perioperative setting while involving anesthesia residents in quality improvement. To achieve this goal, we facilitated direct trainee participation on patient safety and quality improvement initiatives. The result was a project for perioperative hand hygiene improvement conceived and led by anesthesiology residents.

Methods Anesthesiology residents contributed project ideas and participated in problem-based learning discussions to develop several interventions for improving perioperative hand hygiene compliance. Interventions included electronic and laminated posters, reminder cards, monthly aggregated performance feedback, and a simulation-based hand hygiene workshop. Monthly hand hygiene compliance data were gathered during unannounced observations for a 29-month period. Run chart analysis and χ2 test were used to determine the impact of these interventions on compliance rates.

Results A total of 1122 hand hygiene observations were made for 29 months. Run chart analysis showed a nonrandom shift and increasing trend during the postintervention period. The baseline hand hygiene rate was 68% (95% CI [65%–72%], n = 661), which increased to 79% post-intervention (95% CI [76%–83%], n = 461, P < 0.01).

Conclusions Our resident-led hand hygiene program used a multifaceted approach to drive sustained increases in perioperative hand hygiene compliance, while directly engaging house staff in quality improvement initiatives.

From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital; †Department of Infection Control, Brigham and Women's Hospital, Boston, Massachusetts.

Correspondence: Marc Philip T. Pimentel, MD, Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, CWN-L1, Boston, MA 02115 (e-mail:

The authors disclose no conflict of interest.

Supported by a grant from the Partners Healthcare Office of Graduate Medical Education Center of Expertise in Patient Care Quality and Safety, and fellowship support from the Harvard Risk Management Foundation.

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