Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study

Abstract

Background Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the “Prevention of Hospital Infections by Intervention and Training” (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect. Methods We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman’s rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns. Results In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18–0.97], and their median HH increase (ρ = 0.79 [0.08–0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance. Conclusions Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs’ overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.

Individual hand hygiene improvements and effects on healthcare-associated infections: a long-term follow-up study using an electronic hand hygiene monitoring system

“…Third, some of the observed variability in the individual HHC levels could be explained by chance findings due to a limited number of data points collected compared with the grouped analyses. However, an EHHMS and an extended study period were used to increase the number of data points per HCW, which is a limitation of large-scale studies using the direct observation method [14]. Fourth, some HCWs stopped working in the department during the study period, and new staff members started.…”

Implementing strategies to prevent infections in acute-care settings

“…57,58 Specifically, InDepth sought to identify the role contextual factors play in barriers and facilitators to successful implementation. 59 The framework defines 3 qualitative measures of implementation success: The framework has not been applied beyond the PROHIBIT outcomes of CLABSI rates and hand hygiene adherence, 57,58 but the reported results may be used to inform other approaches.…”

“…The European and Mixed-Methods framework derives from the CFIR 27 and originated as the ‘InDepth’ work package, 56 a longitudinal qualitative comparative case study within the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) study. 57,58 Specifically, InDepth sought to identify the role contextual factors play in barriers and facilitators to successful implementation. 59 The framework defines 3 qualitative measures of implementation success: Acceptability: Satisfaction with the intervention. Intervention fidelity: Local implementation matched with the stated goals of the multicenter trial. Adaptation: Local efforts to match the intervention with local context. …”

Clinical Impact of Hand Hygiene by KAP Survey among Medical Students

“…Medical students play a major role in the health care system. Hence it is important for them to have adequate knowledge to carry out practices of hand hygiene with positive attitude 4 . A few studies have been conducted that developed an educational module for the undergraduate students.…”

“…They can potentially transmit or receive infections. Hence medical students need to be educated formally to this basic and essential preventive measure by various modalities like lectures, seminars and workshops 4,6 . In 2009, a campaign was initiated by World Health Organization (WHO), 'Save Lives: Clean Your Hands,' which emphasized the hand washing techniques in a simple way, as it is a fundamental step for prevention against various infectious diseases 7,8 .…”