A quasi-randomized controlled before–after study using performance feedback and goal setting as elements of hand hygiene promotion

Abstract

Hand hygiene (HH) plays an important role in infection prevention but is often suboptimal. To test the potential of goal setting and performance feedback in improving HH. A prospective controlled intervention study was conducted at a German hospital. The study involved four phases: habituation to novel count dispensers and observers (T0), baseline (T1), intervention (T2) and postintervention (T3). Four non-intensive-care units were assigned to one of four conditions: goal setting, performance feedback, both goal setting and performance feedback, or none (control). During all phases, dispenser usage was electronically recorded 24/7. In addition, randomly sampled direct observation was conducted by trained external observers during each phase. The main outcome measure was the daily average of electronically counted hand hygiene events (HHEs) per patient room. In the feedback condition, a marginally significant increase in HHEs was found from T1 to T2 (MT1= 7.3, MT2= 10.3, MT3= 8.2). In the goal-setting condition, HHEs increased only descriptively from T1 to T2 (MT1= 6.8, MT2= 8.7, MT3= 7.8). In the combined condition, HHEs increased significantly from T1 to T2, and were still significantly elevated at T3 (MT1= 7.9, MT2= 17.0, MT3= 12.9). Over all wards and study phases, count dispenser usage frequency was highly correlated with HH compliance (ρ= 0.766, P<0.001). This study suggests that combining goal setting and feedback is a useful approach for improving HH.