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PSNet: Patient Safety Network
Journal Article

Culture change in infection control: applying psychological principles to improve hand hygiene.

Cumbler E, Castillo L, Satorie L, et al. Journal of nursing care quality. 2013;28:304-11.

The seemingly simple act of hand hygiene has proved to be a formidable obstacle in patient safety, as hand hygiene rates remain unacceptably low at many hospitals. This study describes how one hospital reframed hand washing as a social issue at the unit level and used a combination of active leadership and psychological approaches (including immediate feedback) to encourage hand hygiene. The program resulted in a sustained improvement in hand hygiene rates, an accomplishment that has led to a drop in health care–associated infection rates in other studies. The seminal Keystone ICU study used a similar approach—framing infection control as a social issue rather than a disease problem—to successfully reduce catheter-associated bloodstream infections.