Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study

Annette Erichsen Andersson,Maria Frödin,Brigid M Gillespie,Jesper Hök,Lisen Dellenborg,Lars Wallin,Ewa Wikström

doi:10.1186/s12913-017-2783-1

Abstract

BackgroundHand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room.MethodsThe study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach.ResultsDoubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in “safe spaces” worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene.ConclusionEnabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136). Date of registration 2016/11/28, retrospectively registered.

Highlights

Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections
Intervention delivery For an overview of the identified and targeted barriers, theory-based implementation strategies, proposed mechanisms of change, and the knowledge translation (KT) processes used for delivery see Table 1
The facilitators could give examples from the litterateur in support of their observations and initiate a discussion on how these barriers could be addressed. These suggestions were linked to theories but the activities selected were co-created by merging the participants knowledge and experiences with facilitators knowledge and experiences

Summary

Introduction

Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. Implementation of these strategies in the operating room remains suboptimal. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room. As hand hygiene (HH) is regarded one of the most important strategies to prevent HAI and the spread of microorganisms [4,5,6,7,8], finding effective interventions to ensure its sustained use in healthcare is of the utmost importance. There is a paucity of research into interventions aimed at improving HH practices in the OR context [19, 20]

Objectives

Methods

Results

Discussion

Conclusion