Hand hygiene promotion delivered by change agents—Two attitudes, similar outcome

Abstract

Objective:To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care.Design:Randomized-controlled study.Setting:Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia.Methods:We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours.Results:Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%–53%) and 50% (95% CI, 44%–55%) in the preintervention period to 66% (63%–69%) and 65% (60%–69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals.Conclusion:Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.

Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review

“…Two studies (11%) that used a single intervention involved the removal of elements of hygiene procedures to measure the effect of their absence on compliance [60,69]. These included introducing a personal- [67] Medical/surgical ward (1) Direct (52,065) Derde et al [35] Adult ICUs ( 13) Direct (41,558) Chhapola and Brar [79] Neonatal ICU ( 1) Direct (28,726) Mu et al [82] Whole organization (1) Direct (27,852) Aghdassi et al [43] Medical/surgical wards ( 20) Direct (21,424) Reisinger et al [44] Medical/surgical wards þ ICU (11) Direct (13,195) Stewardson et al [61] Whole organization (1) Direct (12,579) Rodriguez et al [87] Adult ICU (1) Direct (10,429) Saharman et al [84] Adult ICUs (2) Direct (7187) Kuruno et al [72] Adult ICU ( 1) Direct (6050) Lee et al [62] Medical/surgical wards (2) Direct (4895) Medeiros et al [89] Adult ICU ( 1) Direct (4837) Labi et al [40] Whole organization (2) Direct (4296) Primary healthcare centre (13) Chakravarthy et al [41] Adult ICUs (3) Direct (3612) Tschudin-Sutter et al [80] Medical/surgical wards ( 12) Direct (2923) Santoaningsih et al [77] Medical/surgical wards ( 5) Direct (2766) Stevenson et al [83] Whole organization ( 1) Direct (2654) Su et al [86] Medical/surgical wards ( 5) Direct (2079) Schmitz et al [37] Medical/surgical wards ( 4) Direct (2000) Diefenbacher et al [65] Medical/surgical wards ( 4) Direct (1894) Apisarnthanarak et al [55] Adult ICUs ( 6) Direct (1872) Fouad and Eltaher [71] Medical/surgical ward (1) Direct (1374) Teesing et al [90] Nursing homes (…”

“…All of these studies used an educational intervention delivered by staff to staff. In the study by Lee et al, staff were identified as HH change agents [62], while Ng et al [78] used an ultraviolet hand scanner glow germ solution to demonstrate the proper HH technique. In the study by Mukherjee et al, surgical internees attended repeated phases of an educational intervention if they did not use the perfect HH technique.…”

“…Only five of the studies that used three interventions [51,62,78,79,81] recorded HH compliance data, while one study [80] did not record baseline compliance although a 10.9% improvement was noted post intervention. These studies all started from relatively high baselines, ranging from 24% to 64%.…”

“…The study by Ng et al involved religious consultation from local religious leaders as part of a HH education programme that acknowledged the appropriateness of using ABHR for HCWs practising the Muslim faith [78]. Lee et al appointed change agents to provide education and feedback on the use of proper HH techniques [62]. Leaders were encouraged to overtly correct, educate and congratulate staff on correct procedure.…”

“…Of the 50 studies that recorded compliance, 34 (68%) directly identified both baseline and postintervention HH compliance in the intervention group. A further 12 studies (24%) [36,44,52,55,57,60,62,67,69,77,78,87] showed the results in tables, and the authors of this review calculated the appropriate percentage results using the tables provided. These include studies that provided results for individual groups involved in the study but did not give an overall figure.…”