Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis

Abstract

ObjeCtiveTo evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. DesignSystematic review and network meta-analysis. Data sOurCesMedline, Embase, CINAHL, NHS Economic Evaluation Database, NHS Centre for Reviews and Dissemination, Cochrane Library, and the EPOC register (December 2009 to February 2014; studies selected by the same search terms in previous systematic reviews .review methODs Included studies were randomised controlled trials, non-randomised trials, controlled before-after trials, and interrupted time series studies implementing an intervention to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies that met predefined quality inclusion criteria. When studies had not used appropriate analytical methods, primary data were re-analysed. Random effects and network meta-analyses were performed on studies reporting directly observed compliance with hand hygiene when they were considered sufficiently homogeneous with regard to interventions and participants. Information on resources required for interventions was extracted and graded into three levels. resultsOf 3639 studies retrieved, 41 met the inclusion criteria (six randomised controlled trials, 32 interrupted time series, one non-randomised trial, and two controlled before-after studies). Meta-analysis of two randomised controlled trials showed the addition of goal setting to WHO-5 was associated with improved compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to 1.76; I 2 =81%). Of 22 pairwise comparisons from interrupted time series, 18 showed stepwise increases in compliance with hand hygiene, and all but four showed a trend for increasing compliance after the intervention. Network meta-analysis indicated considerable uncertainty in the relative effectiveness of interventions, but nonetheless provided evidence that WHO-5 is effective and that compliance can be further improved by adding interventions including goal setting, reward incentives, and accountability. Nineteen studies reported clinical outcomes; data from these were consistent with clinically important reductions in rates of infection resulting from improved hand hygiene for some but not all important hospital pathogens. Reported costs of interventions ranged from $225 to $4669 (£146-£3035; €204-€4229) per 1000 bed days. COnClusiOnPromotion of hand hygiene with WHO-5 is effective at increasing compliance in healthcare workers. Addition of goal setting, reward incentives, and accountability strategies can lead to further improvements. Reporting of resources required for such interventions remains inadequate.

A Systematic Review on the Effectiveness of Interventions to Improve Hand Hygiene Compliance of Nurses in the Hospital Setting

“…Although hand hygiene is considered to be the most effective strategy to reduce the rates of HAIs, compliance rates remain inadequate (Luangasanatip et al, 2015). This has major repercussions on patient outcomes, including increased length of stay, morbidity, and mortality, and it has a financial impact on the healthcare system (Kwon, Olsen, Dubberke, 2015;Levchenko, Boscart, & Fernie, 2011).…”

Händehygiene in Einrichtungen des Gesundheitswesens

“…Ist [372]. Im Rahmen eines solchen Interventionsprogramms haben Fortbildungen insbesondere in standardisierter Form [373] und Training [374] eine Schlüsselfunkti-on, jedoch als alleinige Interventionsmaß-nahme nur einen geringen, kurz anhaltenden Effekt [132,370,371,375].…”

Clean Your Hands 5 th May 2017: ‘Fight antibiotic resistance – it's in your hands’

“…The guidelines include the application of a multimodal strategy that consists in achieving system change (infrastructure and resources), raising awareness, education and training, monitoring and timely feedback and a patient safety culture that includes visibly committed leadership. This approach improves hand hygiene, reduces infections and saves lives [4]. Therefore, on the occasion of the upcoming 5 th May 2017 Global Annual Hand Hygiene Day, WHO urges policy makers, top-level managers, IPC specialists and other health professionals to focus on the fight against AMR spread, by building ever stronger hand hygiene and IPC programmes (Table 1).…”