'Bare below the elbows' quality improvement project shows persistent improvement after a limited feedback intervention

Abstract

Background: Expert opinion is that Bare Below the Elbows (BBE) may reduce the major problem of Healthcare Associated Infections (HAI).1 BBE policy has been adopted by health care organisations including Children's Health Queensland. We elected to enforce this BBE policy as part of our Emergency Departments (ED) 'High Five for Hand Hygiene' multi-modal program.2 We elected to document our interventions3 and to identify barriers and enablers. Objectives: Document interventions that improve BBE while identifying barriers and enablers. Methods: Monthly audit of staff (2-4 pm shift overlap). Results collated on identifiable roster sheets and reported de-identified. A 3-month baseline; 11-month feedback; and a 5-month no-feedback phase. Individual feedback provided to all staff. Senior staff encouraged to role model. Focused emails identified specific non-compliance issues. Results: Compliance increased from baseline 53% (95% CI 37-70%) to 73% (95% CI 61-86%). No further 'step change' was triggered. Reduced watch-wearing and less sleeves contributed to improvement. Compliance in May 2016 was above the 95% upper confidence interval with no watches or sleeves. No reason for this compliance was identified. Focused feedback emails were well received. A few individuals aware of the policy were slow to change. Watch wearing increased during the nofeedback phase. Complex rings remain problematic due to emotional attachment. (Figure Presented) Conclusions: Feedback appeared effective at improving BBE compliance. Change was enabled by senior staff support. Barriers that need to be overcome include emotional attachment to complex rings. Research comparing complex rings to simple bands is required. The BBE project has restarted feedback using a monthly hand hygiene dashboard. A theory informed behavioural change framework is being developed.L6221670902018-05-22 <br />