A 10-week protocol phase-in period was scheduled
by the study team for protocol training of ICU
staff. All members of the nursing staff received verbal
instructions from a study team member and were
monitored for proper return demonstration of the
protocol to improve consistency of their technique
for hand hygiene. An electronic medical record
“intervention” was created to trigger a timely reminder
to perform the PHHP 3 times a day. The prompt in
the electronic medical record also required nurses
to document hand hygiene with a “yes” or “no”
and to provide a comment response. If the nurse
documented “no” (meaning the patient did not
receive hand hygiene), the nurse was required to
enter a comment explaining the rationale. Implementation
and adherence were achieved through
the 10-week training process, where study team
members were present for each scheduled hand
hygiene time (8 AM, 2 PM, and 8 PM). After the training
period, auditing and observation were used to
assess compliance. Resistance was met, as with
any change, and was addressed on a 1-to-1 basis.