“The role as a champion is to not only monitor but to speak out and to educate”: the contradictory roles of hand hygiene champions

Abstract

BackgroundImplementation science experts define champions as “supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.” Many hospitals use designated clinical champions—often called “hand hygiene (HH) champions”—typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term “HH champion” and how they define the role.MethodsAn ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes.ResultsA total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role.ConclusionsHealthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance—and differentiate it from the role of a “compliance auditor.” Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.

A conceptual model to guide research on the activities and effects of innovation champions

“…In addition, champions facilitate development of knowledge and skills needed for effective use of the innovation, for example, by role modeling ( Gordon et al, 2011 ), providing one-on-one mentoring ( Wood et al, 2020 ), or organizing tailored training ( Ash et al, 2003 ). Champions also monitor use of the innovation ( Goedken et al, 2019 ) and trouble-shoot various problems that arise during implementation ( Howell et al, 2005 ). Champions continue their work in the sustainment phase ( Shelton et al, 2018 ), for example, by continuing to monitor use of the innovation and investigating changes in patterns of use ( Laur et al, 2018 ).…”

“…Labeling the strategy as “identifying and preparing champions” is also important because it suggests that the strategy is employed not by the champion but instead by some other organizational member, presumably one holding a leadership position. However, the full range of responsibilities performed by the champion is not specified in the compilation of strategies and remains a gap in the field, as highlighted by a recent study ( Goedken et al, 2019 ). In implementation efforts that use multiple strategies to address different levels of barriers ( Weiner et al, 2012 ), the strategy of identifying and preparing champions likely would be employed within a multifaceted implementation approach, involving other discrete strategies, some of which the champions themselves would lead or be involved with employing.…”

Mask use among health care workers and feelings of safety at work pre- and post- COVID-19 vaccine

“…The benefits of hand washing for infection control have been known for hundreds of years, and yet, hospitals still require reminders and interventions in our effort to reach 100% compliance 21 . A common model is appointing a hand hygiene champion whose role it is to educate, encourage and monitor for proper hand hygiene 22 . Our survey demonstrates that staff have taken it upon themselves to point out lapses in masking and have grown fatigued.…”

La déviance positive : faire autrement pour améliorer l’hygiène des mains des infirmières Positive deviance: Doing things differently to improve hand hygiene of nurses

“…Par ailleurs, quelques auteurs, tels que Hilken et al [18], proposent d'impliquer des infirmières soignantes qui ont du leadership, à titre de « championne », aux programmes de prévention et contrôle des infections. Selon Goedken et al [19], le rôle de championne au regard de l'hygiène des mains pourrait aider à améliorer cette pratique par la promotion, le coaching informel et le rappel à leurs pairs. Cependant, nous sommes en accord avec ces auteurs [19], qu'il peut être complexe d'ajouter ce type de responsabilités à des infirmières qui sont déjà surchargées et qui n'ont peut-être pas l'autorité fonctionnelle pour accomplir ce rôle.…”

“…Selon Goedken et al [19], le rôle de championne au regard de l'hygiène des mains pourrait aider à améliorer cette pratique par la promotion, le coaching informel et le rappel à leurs pairs. Cependant, nous sommes en accord avec ces auteurs [19], qu'il peut être complexe d'ajouter ce type de responsabilités à des infirmières qui sont déjà surchargées et qui n'ont peut-être pas l'autorité fonctionnelle pour accomplir ce rôle.…”