Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90 %

Reich, J; Goodstein, Monica E.; Callahan, Susan E.; Callahan, Kathleen; Crossley, Lindsay; Doron, Shira; Snydman, David R.; Nasraway, Stanley A.

doi:10.1186/s13054-015-1008-4

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…Interventions to specifically improve compliance among physicians may be of particular value, given their relatively poor performance and the lack of attention this group has received; a previous review of HH interventions(6) found only one study targeting physicians only (36).…”

Section: Discussionmentioning

confidence: 99%

Hand Hygiene Compliance in the ICU: A Systematic Review

Lambe

Lydon

Madden

et al. 2019

Critical Care Medicine

132

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Objectives: To synthesize the literature describing compliance with WHO hand hygiene (HH) guidelines in Intensive Care Units (ICUs), to evaluate the quality of extant research, and to examine differences in compliance rates across geographical regions, ICU types, and healthcare worker groups, observation methods, and Moments (indications) of HH. Data sources: Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Reference lists of included studies and related review articles were also screened. Study selection: English-language, peer-reviewed studies measuring HH compliance by healthcare workers in an ICU setting using direct observation guided by the WHO's 'Five Moments of Hand Hygiene', published since 2009, were included. Data extraction: Information was extracted on study location, research design, type of ICU, healthcare workers, measurement procedures, and compliance rates. Data synthesis: Sixty-one studies were included. Most were conducted in high-income countries (60.7%) and in adult ICUs (85.2%). Mean HH compliance was 59.6%. Compliance rates appeared to differ by geographic region (high-income countries 64.5%, low-income countries 9.1%), type of ICU (neonatal 67.0%, pediatric 41.2%, adult 58.2%), and type of healthcare worker (nursing staff 43.4%, physicians 32.6%, other staff 53.8%). Conclusions: Mean HH compliance appears notably lower than international targets. The data collated may offer useful benchmarks for those evaluating, and seeking to improve, hand hygiene compliance in ICUs internationally.

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Section: Discussionmentioning

confidence: 99%

Hand Hygiene Compliance in the ICU: A Systematic Review

Lambe

Lydon

Madden

et al. 2019

Critical Care Medicine

132

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“…However, a greater increase was noted among orthopaedic surgeons before the intervention with a significant difference in the change in slope. This could be because this group were improving from lower baseline compliance (Reich et al, 2015). The slower rate of change after the intervention is likely to be due to the 'ceiling effect' that is met in the attempt to achieve 100% compliance (Wogalter et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

“…The delivery of audit and feedback interventions is complex with different elements influencing outcome including, the characteristics of the recipient, the setting, the type of feedback and organisational characteristics (Ivers et al, 2014b). It has been suggested that HH interventions could be improved by customising feedback to recipients' characteristics, such as professional discipline (Reich et al, 2015).…”

mentioning

confidence: 99%

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

Smiddy

Murphy

Savage

et al. 2019

Journal of Infection Prevention

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Background: Healthcare-associated infection compromises patient safety. Compliance with hand hygiene (HH) guidelines has been shown to be an effective method of reducing infection; however, it remains suboptimal and poorer among doctors compared to other healthcare workers. The aim of this study is to determine the relationship between an individualised observational hand hygiene audit (OHHA) and feedback intervention with observed HH compliance. Methods: We used a retrospective interrupted time series design using OHHA data from a five-year period, 2011–2015. OHHA indicated poorer HH compliance among doctors than other healthcare workers in a 345-bed acute private hospital. An increase in orthopaedic surgical site infection prompted additional auditing of the orthopaedic unit further identifying substandard HH compliance among orthopaedic surgeons. In addition to ongoing HH interventions, an individualised hand hygiene audit and feedback intervention focusing on consultant orthopaedic surgeons was implemented. Observed HH compliance improved. The intervention was then extended to include all consultant doctors at the study site. Audit was implemented by trained clinical nurse managers during clinical rounds. Written audit feedback was provided by the infection prevention and control team. Results: HH compliance increased significantly among both orthopaedic surgeons and other consultant doctors, P < 0.05. Conclusion: An individualised audit and feedback intervention was effective in improving compliance. Incorporation of OHHA with individualised feedback into routine daily practice needs to be considered as a quality improvement opportunity. This study has the potential to inform other audit and feedback interventions to maximise effectiveness and ensure implementation.

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“…Supplemental Digital Content 3. Almost all (92.1%) studies implemented a bundled intervention to improve HH, with only three studies (23)(24)(25) relying upon a single interventional strategy.…”

Section: A Summary Of the Interventions Implemented Within Each Study Is Provided Inmentioning

confidence: 99%

“…Only eight (25,(35)(36)(37)(38)(39)(40)(41) studies provided data relating to the maintenance of intervention effects. The period of follow-up ranged from six weeks (38) to three years (39).…”

Section: A Summary Of the Interventions Implemented Within Each Study Is Provided Inmentioning

confidence: 99%

Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review

Lydon

Power

McSharry

et al. 2017

Critical Care Medicine

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Objective: To synthesize the literature describing interventions to improve hand hygiene (HH) in Intensive Care Units (ICUs), to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described.Data sources: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened.Study selection: English language, peer-reviewed studies that evaluated an intervention to improve HH in an adult ICU setting, and reported HH compliance rates collected via observation, were included.Data extraction: Data were extracted on the setting, participant characteristics, experimental design, HH measurement, intervention characteristics and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist.Data synthesis: Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 out of 24 (SD=2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were Education (78.9%), Enablement (71.1%), Training (68.4%), Environmental Restructuring (65.8%), and Persuasion (65.8%). Intervention outcomes were variable with a mean relative percentage change of 94.7% (SD=195.7; range: 4.3-1155.4%) from pre-to post-intervention.Conclusions: This review demonstrates that best practice for improving HH in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.

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Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90 %

Cited by 17 publications

References 23 publications

Hand Hygiene Compliance in the ICU: A Systematic Review

Hand Hygiene Compliance in the ICU: A Systematic Review

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

Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review

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