Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis

Abstract

Healthcare-associated infections (HCAIs) cause significant morbidity and mortality in neonatal intensive care units (NICUs). Meticulous hand hygiene is the most effective strategy to prevent HCAI. However, hand hygiene compliance (HHC) is low, especially in ICUs. Hence, we aimed to evaluate the efficacy of strategies for improving HHC in NICUs. A systematic review of the literature and meta-analysis were carried out. PubMed, EMBASE, Cochrane CENTRAL and CINAHL were searched in October 2013. PRISMA guidelines were followed. The quality of included studies was assessed by the Newcastle-Ottawa scale (NOS). Sixteen eligible non-randomised studies were included. A total of 27,155 hand hygiene moments were observed. Meta-analysis using a random effects model indicated that a range of strategies, such as educational campaigns, musical parodies, reminders, easy access to hand hygiene sanitisers, UV sensors and performance feedback, improved HHC [odds ratio (OR) 2.04; 95 % confidence interval (CI) 1.40, 2.97]. Significant statistical heterogeneity was noted. Studies which specifically provided performance feedback at either the individual or group levels reported a more significant improvement in HHC compared to those that did not (OR 2.81; 95 % CI 1.32, 5.96 vs. OR 1.55; 95 % CI 1.13-2.11). Strategies to improve HHC in NICUs seem to be more effective when they include performance feedback at the personal or group levels. Randomised controlled trials (RCTs) specifically assessing the benefits of performance feedback in improving HHC are needed.

Predictors of hand hygiene practice among Saudi nursing students: A cross-sectional self-reported study

“…The significance of educational interventions in improving the practice of hand hygiene has been well documented [30,31]. Educational interventions regarding hand hygiene, such as educational campaigns, reminders, and in-service training, can significantly enhance the practice of hand hygiene [32]. These educational interventions may increase the awareness of hand hygiene and thus improve its practice.…”

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

“…Previous data from participating facilities shows that current models of stepdown training on hand hygiene and IPC are inadequate, didactic, irregularly given and accompanied by little to no oversight (28). In addition to general improvements to the overall infection control and hand hygiene training (36,(41)(42)(43), our data suggest that adherence to hand hygiene protocols speci c to the post-natal care areas should be emphasised and integrated into multi-modal infection control strategies (36,43).…”

“…Our study shows that in the context of newborn care in the HCF, the 'point of care' should expand beyond delivery ward and include post-natal care areas. In the absence of hygiene infrastructure, alcohol-based hand rubs have been shown to improve hand hygiene practices and may be an effective low cost intervention for consideration (34)(35)(36)(37)(38).…”

Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews

“…Overall, 19 systematic reviews (n = 20 articles) were included. 18,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Reference list checks did not identify any further papers.…”