On Hand Hygiene Compliance and Diminishing Marginal Returns: An Empirically-Driven Agent-Based Simulation Study

Thomas Hornbeck, David Naylor, Alberto Maria Segre, Geb Thomas, Ted Herman, Philip M. Polgreen

Failure of healthcare workers to perform hand hygiene is one of the leading preventable causes of healthcare-associated infections. Despite targeted interventions to improve hand-hygiene compliance, rates remain relatively low (averaging less than 50%) in many healthcare settings. Since it is much harder to raise compliance rates when rates are already high, achieving 100% compliance may ultimately be infeasible or cost prohibitive. In this paper, we use agent-level simulations empirically grounded in fine-grained healthcare-worker movement data collected by wearable sensors deployed in a working intensive care unit to explore the effect of hand-hygiene compliance on the spread of healthcare-associated infections. These simulations permit us to determine if a “law of diminishing returns” applies to hand hygiene: in other words, is achieving 100% compliance always worth the cost?

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