Impact of multimodal interventions targeting behavior change on hand hygiene adherence in nursing homes: An 18-month quasi-experimental study

Abstract

Nursing home residents are vulnerable and frail, and hand hygiene adherence is often too low to prevent transmission of infections. This study's aim was to investigate whether interventions targeting behavior change can improve hand hygiene adherence in nursing homes. Over 18 months, 22 nursing home wards participated in this quasi-experimental study. Three intervention wards were selected based on the mean values of hand hygiene adherence, infections, and antibiotic use. Multimodal interventions targeting behavior change, including education, UV-light boxes, and posters, were implemented. Hand hygiene adherence increased to 60.9% in the intervention wards and decreased to 51.3% in the control wards. The control wards experienced lower adherence in all indications of WHO's "My five moments for hand hygiene." Interventions should target proper hand hygiene before patient contact and glove use because health care workers have low adherence in these areas. The findings indicate that the type of intervention is less important than attention to hand hygiene and activating workers' motivation. Using a behavior change approach and continuous reinforcement is important because the effects of interventions diminish over time. Our findings showed that multimodal interventions targeting behavior change may increase hand hygiene adherence.