Pilot randomised controlled trial to improve hand hygiene through mindful moments

Abstract

BackgroundTo evaluate the effectiveness of a brief mindfulness intervention on hand hygiene performance and mindful attention for inpatient physician teams.DesignA pilot, pre-test/post-test randomised controlled mixed methods trial.SettingOne academic medical centre in the USA.ParticipantsFour internal medicine physician teams consisting of one attending, one resident, two to three interns and up to four medical students.InterventionA facilitated, group-based educational discussion on how mindfulness, as practised through mindful hand hygiene, may improve clinical care and practices in the hospital setting.Main outcomes and measuresThe primary outcome was hand hygiene adherence (percentage) for each patient encounter. Other outcomes were observable mindful moments and mindful attention, measured using the Mindfulness Attention Awareness Scale, from baseline to post-intervention, and qualitative evaluation of the intervention.ResultsFor attending physicians, hand hygiene adherence increased 14.1% in the intervention group compared with a decrease of 5.7% in the controls (P=0.035). For residents, the comparable figures were 24.7% (intervention) versus 0.2% (control) (P=0.064). For interns, adherence increased 10.0% with the intervention versus 4.2% in the controls (P=0.007). For medical students, adherence improved more in the control group (4.7% intervention vs 7.7% controls; P=0.003). An increase in mindfulness behaviours was observed for the intervention group (3.7%) versus controls (0.9%) (P=0.021). Self-reported mindful attention did not change (P=0.865).ConclusionsA brief, education-based mindfulness intervention improved hand hygiene in attending physicians and residents, but not in medical students. The intervention was well-received, increased mindfulness practice, and appears to be a feasible way to introduce mindfulness in the clinical setting. Future work instructing clinicians in mindfulness to improve hand hygiene may prove valuable.Trial registration numberNCT03165799; Results.

The impact of mindfulness‐based interventions on doctors’ well‐being and performance: A systematic review

“…Scores for the quality of the studies ranged between 6.5 and 14.5 on the MERSQI scale; the mean score was 9.9, reflecting average quality (Table S2) . The eligible studies included seven randomised controlled trials (RCTs), three non‐randomised controlled trials (CTs), 12 pre‐post studies, and two qualitative interview studies (Table ). Of the RCTs and CTs, four studies employed a waitlist control condition, four studies employed a passive control condition, and two studies exposed controls to protected free time during the intervention period .…”

Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment

“…A recent empirical study [29] has shown that physicians practice hand hygiene in their daily work more frequently after a one-hour mindfulness-intervention. The focus of this intervention was neither specialized subject knowledge nor particular abilities, but more consciousness and presence in the daily work.…”

“…Besides, communication seminars for employees can also be beneficial – especially when they aim at maintaining hygiene rules within the team (nursing staff, therapists, physicians, [42]). Furthermore, increased attention promotes hygiene competence, for example implemented through evaluations, mentoring, feedback, institution-internal and national/international campaigns [1], [41]) or awareness-focused programs [29]. A further aspect important in this respect are role-models, who influence young clinicians in their behavior [30], [31], [43], [44].…”

Measuring Hygiene Competence: A Vignette-Based Situational Judgement Test

“…In pandemics like COVID-19 in the year 2020, the prevention of infection through good hygiene is crucial. Some pre-existing forms of intervention are designed to increase awareness and improve attitudes towards hygiene in daily clinical work [3][4][5].…”