The Safety Stand-down

Dennis Cunningham, Richard J Brilli, Richard E McClead, J Terrance Davis

Hand hygiene (HH) is critical to prevent health care-acquired infections. However, compliance by health care workers remains between 30% and 70% at most institutions. Most efforts to improve compliance have proven ineffective. The objective of this study was to determine whether a safety stand-down can improve HH compliance. We adapted and borrowed from the military an approach known as a stand-down. A mandatory Hand-Hygiene Leadership Safety Summit was called for all hospital leaders-physicians and nonphysicians. Four days later, a hospital-wide 15-minute-long safety stand-down occurred, during which all nonessential activity was suspended and action plans to improve HH compliance were discussed. All medical sections and hospital departments were required to submit written action plans. After the stand-down, HH compliance monitoring was increased, and noncompliers were required to speak to senior hospital administration. Compliance increased from less than 65% to greater than 95% (P < 0.001) and has been sustained for 3½ years. A health care safety stand-down can be an effective method to rapidly change and sustain culture change regarding HH in the inpatient hospital setting.