Efficacy of observational hand hygiene audit with targeted feedback on doctors’ hand hygiene compliance: A retrospective time series analysis

Smiddy, Maura P.; Murphy, Olive; Savage, Eileen; Fitzgerald, Anthony P.; Sullivan, Brenda O'; Murphy, Catriona; Bernard, Margaret; Browne, John

doi:10.1177/1757177419833165

Cited by 18 publications

(13 citation statements)

References 27 publications

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“…Having a sense of urgency seems to be an important precondition for healthcare professionals to engage: if healthcare professionals perceive the current situation as untenable for themselves or for the safety of patients, this will urge them to take action [ 82 , 105 ]. Several studies have described local audits that were started by intrinsically motivated healthcare professionals on issues they felt to impact on patient care [ 48 , 53 , 61 , 63 , 69 , 82 , 88 , 97 , 99 , 103 ]. In contrast, if healthcare professionals perceive an audit as a ‘side-line’ or ‘mandatory exercise’, rather than a process to contribute to improved quality of care, they will not feel engaged and not put significant effort into the change [ 77 , 118 ].…”

Section: Resultsmentioning

confidence: 99%

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

et al. 2021

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Background Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. Methods A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context–mechanism–outcome configurations (CMOcs). Results From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. Conclusions This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO registration CRD42016039882.

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Section: Resultsmentioning

confidence: 99%

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

et al. 2021

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“…We provided real-time performance feedback to non-compliers to raise their awareness of the importance of compliance for patient safety, a strategy that helped raise compliance after every drop, such as seen in November and December 2016, and August 2017. Several previous studies have shown that provision of real-time individual or group feedback was associated with improvement and sustainability of high compliance rates [21][22][23][24], as well as reduction in serious nosocomial infections such as central line-associated blood stream infections [25].…”

Section: Discussionmentioning

confidence: 99%

Sustaining compliance with hand hygiene when resources are low: A quality improvement report

et al. 2020

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Background Sustainability of hand hygiene is challenging in low resource settings. Adding ownership and goal setting to the WHO-5 multimodal intervention may help sustain high compliance. Aim To increase and sustain compliance of nursing and medical staff with hand hygiene in a tertiary referral center with limited resources. Methods A quality improvement initiative was conducted over two years (2016–2018). After determining baseline compliance rates, the WHO-5 multimodal intervention was implemented with staff education and training, system change, hospital reminders, direct observation and feedback, and hospital safety climate. Additionally, the medical staff was responsible for continuous surveillance of compliance ( ownership ) until rates above 90% were achieved and sustained ( goal setting) . Results Of 2987 observations collected between August 2016 and April 2018, 1630 (54.5%) were before, and 1357 (45.5%) were after patient encounters. The average overall compliance with hand hygiene was sustained at 94% for nursing and medical staff. Two instances of drops below 90% were associated with incidence of nosocomial Rotavirus infections. There were no similar infections during intervention periods with compliance rates above the set goal. Analysis using p-charts revealed significant improvement in compliance rates from baseline (χ 2 (1) = 7.94, p = 0.005). Conclusion Adding ownership and goal setting to the WHO-5 multimodal intervention may help achieve, and sustain high rates of compliance with hand hygiene. Involving health care workers in quality improvement initiatives is feasible, durable, reliable, and cheap, especially in settings with limited financial resources.

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“…The SMSS can be used to conduct audits and provide feedback to grantees committed to sustaining prevention programs and initiatives once initial funding has ended. are recognized as important for prevention [19,20], much of the relevant science on feedback in health has involved improvement in clinical performance [21][22][23][24][25][26][27]. This includes clinical supervision and use of technology like electronic dashboards in measurement-based quality improvement (MBQI) strategies that monitor patient behavior and clinician activity [28][29][30], while prevention has a more limited history of using computational technologies for monitoring [31][32][33][34].…”

Section: Contributions To the Literaturementioning

confidence: 99%

Measurement of sustainment of prevention programs and initiatives: the sustainment measurement system scale

et al. 2020

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Background: Enhancing the sustainability of evidence-based prevention programs for mental and behavioral health requires tools for measuring both sustainability determinants and sustainment outcomes. The aim of this study was to develop the Sustainment Measurement System Scale (SMSS) and to assess its reliability and construct validity for measuring both determinants and outcomes of efforts to sustain prevention programs and initiatives. Methods: A 42-item scale comprised of items identified from qualitative data collected from 45 representatives of 10 programs and 8 SAMHSA program officers was administered to 186 representatives of 145 programs funded by 7 SAMHSA prevention grant initiatives. Cronbach's alphas were used to determine inter-item reliability. Convergent validity was assessed by comparisons of a global measure of sustainment with current SAMHSA-funding status and continued operation in the same form. Discriminant validity was assessed by comparisons of sustainability determinants with whether or not the program had undergone adaptations. Results: Confirmatory factor analysis provided support for a 35-item model fit to the data. Cronbach's alpha was .84 for the sustainment outcome construct and ranged from .70 to .93 for the sustainability determinant constructs. All of the determinant constructs were significantly associated with sustainment outcome individual and global measures for the entire sample (p < 0.01 to 0.001) and for community-based programs and programs with a substance abuse focus (p < 0.05 to 0.001). Convergent validity was supported by significant associations between the global sustainment measure and current SAMHSA funding status and continued operation in the same form (p < 0.001). Four of the sustainability determinant constructs (responsive to community needs; coalitions, partnerships, and networks; organizational staff capability; and evaluation, feedback, and program outcomes) were also significantly associated with current SAMHSA funding status (p < 0.5 to 0.01). With the exception of organizational staff capability, all sustainability determinants were unrelated to program adaptation as predicted. Conclusions: The SMSS demonstrated good reliability and convergent and discriminant validity in assessing likelihood of sustainment of SAMHSA funded prevention programs and initiatives. The measure demonstrates potential in identifying predictors of program sustainment and as a tool for enhancing the likelihood of successful sustainment through ongoing evaluation and feedback.

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Efficacy of observational hand hygiene audit with targeted feedback on doctors’ hand hygiene compliance: A retrospective time series analysis

Cited by 18 publications

References 27 publications

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

Understanding how and why audits work in improving the quality of hospital care: A systematic realist review

Sustaining compliance with hand hygiene when resources are low: A quality improvement report

Measurement of sustainment of prevention programs and initiatives: the sustainment measurement system scale

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