Efficacy of a New Educational Tool to Improve Handrubbing Technique amongst Healthcare Workers: A Controlled, Before-After Study

Abstract

IntroductionHand hygiene is a key component of infection control in healthcare. WHO recommends that healthcare workers perform six specific poses during each hand hygiene action. SureWash (Glanta Ltd, Dublin, Ireland) is a novel device that uses video-measurement technology and immediate feedback to teach this technique. We assessed the impact of self-directed SureWash use on healthcare worker hand hygiene technique and evaluated the device's diagnostic capacity.MethodsA controlled before-after study: subjects in Group A were exposed to the SureWash for four weeks followed by Group B for 12 weeks. Each subject's hand hygiene technique was assessed by blinded observers at baseline (T0) and following intervention periods (T1 and T2). Primary outcome was performance of a complete hand hygiene action, requiring all six poses during an action lasting ≥20 seconds. The number of poses per hand hygiene action (maximum 6) was assessed in a post-hoc analysis. SureWash's diagnostic capacity compared to human observers was assessed using ROC curve analysis.ResultsThirty-four and 29 healthcare workers were recruited to groups A and B, respectively. No participants performed a complete action at baseline. At T1, one Group A participant and no Group B participants performed a complete action. At baseline, the median number of poses performed per action was 2.0 and 1.0 in Groups A and B, respectively (p = 0.12). At T1, the number of poses per action was greater in Group A (post-intervention) than Group B (control): median 3.8 and 2.0, respectively (p<0.001). In Group A, the number of poses performed twelve weeks post-intervention (median 3.0) remained higher than baseline (p<0.001). The area under the ROC curves for the 6 poses ranged from 0.59 to 0.88.DiscussionWhile no impact on complete actions was demonstrated, SureWash significantly increased the number of poses per hand hygiene action and demonstrated good diagnostic capacity.

Simplifying the WHO ‘how to hand rub’ technique: three steps are as effective as six—results from an experimental randomized crossover trial

“…Adherence to all six steps has been reported to be as low as 0% [5] and 8.5% [3,4,8]. Despite the importance of achieving adequate coverage of fingertips and thumbs with hand rub, adherence to the two respective steps of the reference technique specifically focusing on these areas ranged from 19.5 to 34.4% and 8.2 to 42.5% [4,5]. Such observations call for a more applicable approach, which still needs to ensure sufficient degrees of bacterial killing for maximal patient safety.…”

“…Repeated training of healthcare workers (HCW) is required to ensure performance of all six steps [2,3], but despite such interventions, adherence to this technique remains low [4,5].…”

Video didactic at the point of care impacts hand hygiene compliance in the neonatal intensive care unit (NICU)

“…Stewardson et al. employed an instructional video that workers viewed in a break room removed from their worksite . They did not achieve statistical significance in their primary outcome.…”

“…Stewardson et al. did evaluate the technique of HCWs as compared to the European Standards (EN 1500–1997), which involves six distinct steps, or “poses.” They employed an automated visual recognition system to audit the number of poses completed by HCWs before and after viewing an instructional video . There was no statistically significant effect on HCW compliance with all six poses, but there was an increase in the total number of poses completed per subject.…”

The impact of automatic video auditing with real-time feedback on the quality and quantity of handwash events in a hospital setting

“…AVA has been shown to improve training outcomes. [20][21][22] To our knowledge, this study represents the first use of AVA to measure handwashing quality at sinks and to provide individualized real-time feedback on technique.…”