Impact of patient and visitor hand hygiene interventions at a pediatric hospital: A stepped wedge cluster randomized controlled trial

Abstract

Patient and visitor hand hygiene has the potential to prevent health care-associated infections, but there are few data on the efficacy of interventions to improve patient/visitor hand hygiene. To determine whether conventional and front-line ownership (FLO) patient/visitor hand hygiene interventions improve patient/visitor and health care worker (HCW) hand hygiene rates. A stepped wedge cluster randomized controlled trial was conducted on inpatient units and the emergency department. A conventional intervention included pediatric-focused posters, which also served as reminders for HCWs. This was compared to a FLO intervention aimed at finding "positive deviants," staff who were already taking steps to improve patient/visitor hand hygiene. Patient/visitor and HCW hand hygiene rates were measured covertly by trained medical students. Patient/visitor hand hygiene rates increased from 9.2% at baseline to 13.9% in the post-intervention period. Hand hygiene rates on units randomized to the standard intervention changed from 7.3% to 10.9% (P = .46), but FLO intervention units significantly changed from 14.3% to 25% (P = .03). The baseline HCW hand hygiene rate was 68.2%, which increased to a greater extent in the FLO group (79.1%) than in the standard intervention (73.1%), but the change was not statistically significant for either intervention compared to control (P = .18 and P = .64, respectively). Hand hygiene interventions in hospitals can improve patient/visitor and HCW hand hygiene rates, and a FLO intervention appears to be more effective than a conventional intervention.