Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit

Abstract

Context:The role of hand hygiene in preventing health care associated infections (HCAIs) has been clearly established. However, compliance rates remain poor among health care personnel.Aims:a) To investigate the health care workers’ hand hygiene compliance rates in the intensive care unit (ICU), b) to assess reasons for non-compliance and c) to study the efficacy of a multimodal intervention strategy at improving compliance.Settings:A mixed medical–surgical ICU of a tertiary level hospital.Design:A before–after prospective, observational, intervention study.Materials and Methods:All health care personnel who came in contact with patients in the ICU were observed for their hand hygiene compliance before and after a multimodal intervention strategy (education, posters, verbal reminders and easy availability of products). A self-report questionnaire was also circulated to assess perceptions regarding compliance. Statistical analysis was done using χ2 test or Fisher exact test (Epi info software).Results:Hand hygiene compliance among medical personnel working in the ICU was 26% and the most common reason cited for non-compliance was lack of time (37%). The overall compliance improved significantly following the intervention to 57.36% (P<0.000). All health care worker groups showed significant improvements: staff nurses (21.48–61.59%, P<0.0000), nursing students (9.86–33.33%, P<0.0000), resident trainees (21.62–60.71%, P<0.0000), visiting consultants (22–57.14%, P=0.0001), physiotherapists (70–75.95%, P=0.413) and paramedical staff (10.71–55.45%, P< 0.0000).Conclusions:Hand hygiene compliance among health care workers in the ICU is poor; however, intervention strategies, such as the one used, can be useful in improving the compliance rates significantly.

The Effect of Hand Hygiene Strategy on Internship Nurses Compliance at Alexandria University Hospitals: An Empirical Interventional Study

“…Unfortunately, compliance to hand hygiene guidelines was the lowest in Critical care areas, though those patient are highly vulnerable to infection. So, asserting HCWSknowledge and awareness grant them efficiently ameliorated compliance with hand hygiene (39,40) .The present study findings showed statistical significant differencesamong the Critical, Administration, and Medical-Surgical departmentsat bothmorning and evening shifts. The mean percent score of the internship nurses compliance to HH action in the Critical care department was much better than the Administration and Medical-Surgical department.…”

“…A highly statistical significant difference was present between the two departments. 40.0 %, 51.4 %, 48.6%) of participants were non-complying to HH after body fluid exposure risk, afterand before touchingpatients and aftertouching surroundings. in relation to obstetric department, the findings show that more than half of the study sample were non-compliant to HH as compared to the first month.…”

“…The mean percent score of the internship nurses compliance to HH action in the Critical care department was much better than the Administration and Medical-Surgical department. Forevening shift, the Administration department showed higher mean percent score of compliance than those in the other two departmentsa study done by Mathai, et al (2011) in a tertiary level ICU, found that HH compliance between health care workers in the ICU was poor before a HH interventional strategy, but the overall compliance improved significantly following the intervention (41) . After three months of the current studied strategy, there was a significant decline in the mean percent score of nurses' compliance to HH action in the three studied departments.…”

“…This could be explained by lack of periodic students' observation, guidance, role models,and lack of incentives, and intuitional guidelinesthat might becontributing factors to these results.These resultswere in congruent with a study by Silva, et al (2007) who did not find any effect after three months of education (39) . In this regard, Wandel et al (2010)claimed that enhancing HH compliance was not achieved neither with a high level of knowledge nor with social influence (40) . In contrast to these findings, Silmah, et al (2016), and Ahmed, et al (2006) reported greatest improvement in HH knowledge and compliance among hcws immediately and three months following a hospital-wide educational intervention (42,43) average adherence with HH recommendations is usually estimated to be below, but varies between different hospital departments, among professional categories, and according to working conditions (44) .…”

Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review

“…23 Specifically, interventions relied heavily on audit and feedback, education, and positive reinforcement. 7,11,13,15 Whereas positive reinforcement is an important construct in the behaviourist approach, the suitability and sustainability of interventions that rely on rewarding appropriate hand hygiene behaviour is questionable.…”