Impact of a Plan-Do-Check-Act Hand Hygiene Bundle on Compliance, Infection Rates, and Nursing Quality: A Controlled Before-and-After Study

Hand hygiene remains one of the most important measures for preventing hospital-acquired infections, yet sustained compliance in routine inpatient care remains difficult to achieve through reminders or training alone. This study evaluated the effect of a Plan–Do–Check–Act (PDCA)-based hand hygiene governance bundle on hand hygiene compliance, hospital-acquired infection rates, and nursing management quality. A controlled before-and-after study was conducted in 16 inpatient wards of a general hospital. Eight wards received a PDCA-based hand hygiene governance bundle, while eight control wards continued routine hand hygiene management. The study covered a 12-month period, including a 6-month pre-intervention period and a 6-month post-intervention period. The ward-month was used as the main analytical unit. The primary outcome was monthly hand hygiene compliance. Secondary outcomes included hospital-acquired infection rate per 1,000 patient-days and nursing management quality score. Difference-in-differences models were used to estimate intervention-associated changes. Hand hygiene compliance increased from 66.2% to 83.2% in the intervention group and from 63.1% to 66.8% in the control group. The adjusted difference-in-differences odds ratio (OR) for hand hygiene compliance was 2.38 (95% CI: 2.19–2.59, P < 0.001; Table 3). Hospital-acquired infection rates decreased from 7.07 to 4.37 per 1,000 patient-days in intervention wards, with an adjusted incidence rate ratio of 0.60 (95% CI: 0.52–0.69, P < 0.001). Nursing management quality scores increased more substantially in intervention wards than in control wards. The PDCA-based hand hygiene governance bundle was associated with improved hand hygiene compliance, lower hospital-acquired infection rates, and higher nursing management quality. Embedding hand hygiene into repeated ward-level governance cycles may provide a practical strategy for strengthening infection-control management.