Abstract

BackgroundHand hygiene (HH) is the most important measure for preventing healthcare-associated infections. A significant correlation between alcohol-based handrub consumption (AHRC) and observed HH compliance rates has been established. In France, publicly reported AHRC displayed a large heterogeneity across healthcare facilities (HCFs). We aimed to describe programmes for promoting HH in the top and medium AHRC scorers and to assess factors and drivers leading to a high AHRC score in a panel of French HCFs.MethodsWe performed a nationwide qualitative comparative case study based on in-depth semi-structured interviews in 16 HCFs with high, 4-year AHRC scores, and a sample of seven university hospitals (UHs) with medium AHRC scores. Infection Prevention and Control Team (IPC) members (n = 62), quality managers/chief executive officers (n = 23) and frontline workers (n = 6) were interviewed, using a grounded theory approach and an iterative thematic approach.ResultsNinety-one interviews were performed. There was a large heterogeneity in IPC structures and objectives, with specific patterns associated with high AHRC that were more organisational than technical. Four areas emerged: (1) strong cohesive team structure with supportive and outcome-oriented work attitude, (2) IPC structure within the organization, (3) active support from the institution, (4) leadership and role model. Among high AHRC scorers, a good core IPC organisation, a proactive and flexible management, a frequent presence in the clinical wards, and working in a constructive safety climate were prominent.ConclusionWe highlighted that IPC structure and activity is heterogeneous, with organisational and behavioural characteristics associated with high AHRC score. Beyond technical challenge, our work underlines the importance of strong structure of the IPC and behavioural approaches in implementing key IPC programmes.

Highlights

  • Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections

  • Several studies have focused on institutional factors that can influence HH compliance at the level of the clinical wards [10, 11], or local institution [12,13,14], but few considered these issues from the Infection Prevention and Control (IPC) teams viewpoint

  • There was a large heterogeneity in IPC structures and programmes with specific patterns associated with high alcohol-based handrub consumption (AHRC)

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Summary

Introduction

Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. We aimed to describe programmes for promoting HH in the top and medium AHRC scorers and to assess factors and drivers leading to a high AHRC score in a panel of French HCFs. Hand hygiene (HH) is the most important prevention measure of healthcare-associated infections (HAIs) and transmission of multidrug-resistant organisms (MDRO) [1]. Several studies have focused on institutional factors that can influence HH compliance at the level of the clinical wards [10, 11], or local institution [12,13,14], but few considered these issues from the Infection Prevention and Control (IPC) teams viewpoint. We aimed to assess factors and mechanisms leading to a high AHRC score in a panel of French HCFs and compare IPC organisation between top and medium scorers

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