Methicillin Sensitive Staphylococcus Aureus (MSSA) is a commensal associated with hospital acquired infection (HAI). MSSA HAI is associated with significant morbidity, and hand hygiene has been identified as a prominent component of HAI prevention strategies.


A project using Quality Improvement methodology was devised to improve rates within the surgical department: a locally identified MSSA HAI hotspot. Baseline monitoring was done using WHO checklists and departmental education presented on hand hygiene. Continued weekly auditing and feedback was carried out by the multidisciplinary team (MDT) on one ward over a four-month period, and adherence was prompted by verbal reminders and departmental education. A long-term strategy was employed for regular monitoring with a nominated member of the MDT to maintain improvements.


Baseline audit revealed adherence of 10-52% for registrar-led rounds, and 22-62% for consultant-led, across the 5 points of hand hygiene. Particular weakness was noted before patient contact and entry to clinical areas, which was addressed with departmental education. Initial adherence after education was low (6-38%), but subsequent improvement was seen the following month (74-93%). Some of this was maintained over the final two months of data collection (50%-100%), and a PDSA cycle was employed to address this variability. As such, an MDT-wide monitoring schedule was put in place at the end of the data collection period.


This QI project sought to achieve sustainable change in adherence to hand hygiene. An MDT-wide system of monitoring and education effected this, and may prove an effective strategy in similar inpatient settings.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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