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