Improve Hand Hygiene Adherence Research Articles

Effect of the implementation of infection prevention measures by an infection prevention link physician in trauma/orthopaedics surgery a onto hygiene-relevant processes and nosocomial infections

BackgroundThe German Infection Protection Act and KRINKO recommend nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). Detailed evidence on the contribution of PLPs to reducing infection rates is not available in Germany. AimThe "HygArzt"-study investigated whether , and to what extent, a PLP in orthopaedics/trauma surgery is able to improve hand hygiene adherence (HHA), process steps of dressing change, nosocomial infection (NI) and surgical site infection (SSI) rates by implementing an infection prevention bundle (IPB). MethodsIn consideration of a literature review on infection prevention measures in orthopaedics/trauma surgery and existing departmental hygiene standards, supported by the responsible infection control specialist, an IPB was developed by an interdisciplinary team and implemented by a PLP. The effects of IPB on NI, SSI, and HHA were determined in a pre-post study design on three trauma surgery/orthopaedic wards of a university hospital. FindingsIn pre-post comparison HHA was significantly increased, and NI rates were reduced significantly. The greatest increase in adherence occurred in the pre-indications "Before touching a patient" (pre: 37.3%; post: 73.0%), "Before clean/aseptic procedure" (pre: 34.2%; post: 75.5%) and "Before surgery" (pre: 9.7%; post: 57.0%). The analysis of NI and SSI rates (NI: p=0.03; SSI: p=0.01; relative risk (RR) of 0.53 in each case) revealed rate reductions. ConclusionThe implementation of an IPB by a PLP led to an optimisation of processes and to a reduction of SSIs and NIs. PLPs seem to have the potential for targeted, group-specific implementation of complex IPBs.

Improving Hand Hygiene Adherence in Small Animal Hospitals: A Social Marketing Approach

Background Good hand hygiene adherence is a key factor in the prevention of hospital-acquired infections. The guidelines offered by the World Health Organization for interventions to improve hand hygiene adherence in human health care can only in part be applied to veterinary medicine, and current observations of hygiene adherence in veterinary environments stress a need for decisive action. There is great potential for improvement, especially in situations in which people act habitually. Focus of the Article The focus of this article is to identify the barriers and benefits that influence hand hygiene habits in veterinary care facilities and to derive intervention strategies to promote hand hygiene habits informed by theory and formative research. Research Question This article examines two research questions. What contextual, social, and personal factors promote (benefits) and hinder (barriers) hand hygiene habits in veterinary care facilities? Which intervention strategies can be derived from the identified barriers and benefits to foster hand hygiene habits? Approach The identification of the target behavior and group was based on the literature, talks within the author team, and daily observations. Barriers and benefits were identified by means of qualitative focus groups. The focus group interview schedule was informed by the risks, attitudes, norms, abilities, and self-regulation (RANAS) approach. The intervention strategy was based on the elicited barriers and benefits and guided by the framework of habit formation. Importance to the Social Marketing Field For the first time, barriers and benefits regarding hand hygiene habits were systematically elicited in a small animal clinic in Switzerland. The article focuses on hand hygiene as a habit and offers evidence-based and behavior-oriented intervention strategies. Our findings can thus be used as a basis for developing a theoretically sound intervention to promote hand hygiene habits in veterinary clinics and practices and serve as a springboard for future social marketing research, especially with a focus on habit formation. Methods Primary data were gathered using eight structured in-depth focus group interviews ( N = 32 participants) in a small animal clinic in Switzerland. Two focus groups each were conducted with the following professional groups: veterinary assistants, students, residents and interns, and senior clinicians. Results The overarching theme across the participants’ talk was that building habits is promising but challenging to implement. In examining the key barriers and benefits, five themes were discussed: (1) animal welfare as a reason to act, (2) not about the why but about the how, (3) clash of generations, (4) lack of feedback mechanisms, and (5) the invisible enemy. Strategies were derived based on these findings and the theoretical framework of a habit formation intervention. Recommendations for Practice and Research The themes that emerged in the focus groups are connected to the theoretical framework of habit formation to derive possible intervention strategies. The supplemental material delves into these strategies and provides implementation steps for practitioners facing a similar challenge. Further research is needed to experimentally test the effect of the intervention strategies and to validate the results for other clinics.

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

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.

WHO ‘My five moments for hand hygiene’ in anaesthesia induction: a video-based analysis reveals novel system challenges and design opportunities

Anaesthesia induction is a fast-paced, complex activity that involves a high density of hand-to-surface exposures. Hand hygiene (HH) adherence has been reported to be low, which bears the potential for unnoticed pathogen transmission between consecutive patients. To study the fit of the World Health Organization's (WHO) five moments of HH concept to the anaesthesia induction workflow. Video recordings of 59 anaesthesia inductions were analysed according to the WHO HH observation method considering each hand-to-surface exposure of every involved anaesthesia provider. Binary logistic regression was used to determine risk factors for non-adherence, i.e. professional category, gender, task role, gloves, holding of objects, team size and HH moment. Additionally, half of all videos were recoded for quantitative and qualitative analysis of provider self-touching. Overall, 2240 HH opportunities were met by 105 HH actions (4.7%). The drug administrator role (odds ratio (OR): 2.2), the senior physician status (OR: 2.1), donning (OR: 2.6) and doffing (OR: 3.6) of gloves were associated with higher HH adherence. Notably, 47.2% of all HH opportunities were caused by self-touching behaviour. Provider clothes, face, and patient skin were the most frequently touched surfaces. The high density of hand-to-surface exposures, a high cognitive load, prolonged glove use, carried mobile objects, self-touching, and personal behaviour patterns were potential causes for non-adherence. A purpose-designed HH concept based on these results, involving the introduction of designated objects and provider clothes to the patient zone, could improve HH adherence and microbiological safety.

Improving research personnel's hand hygiene adherence in the pediatric acute care setting during the COVID-19 pandemic: a quality improvement initiative.

Hand hygiene is critical in preventing the spread of healthcare-associated infections. Routine hand hygiene surveillance and education are common for clinical staff in pediatric acute care settings. However, nonclinical staff, including research personnel, are often excluded from these programs and therefore represent a gap in ongoing infection control efforts. This project aimed to evaluate the impact of evidence-based interventions on improving hand hygiene adherence among research personnel in the pediatric emergency department to meet provincial targets set for clinical staff. We used a Plan-Do-Study-Act approach to carry out a peer-driven, multimodal hand hygiene improvement strategy involving education, surveillance, and feedback targeted to research assistants working in a pediatric emergency department. Two anonymous peer evaluators observed hand hygiene practices in several specific instances (eg, before/after patient interactions) and determined adherence a priori. In an open sample of clinical research assistants (Ntotal = 22), hand hygiene adherence increased from 12.5% to 89.1% over 11 months. Increases in adherence were particularly notable before entering the patient environment compared to exiting. Hand hygiene interventions targeting research personnel show potential success in acute care. Further quality improvement initiatives in larger research personnel samples must robustly evaluate the framework's effectiveness.

Students\u2019 observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic

BackgroundHealthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not.MethodsThis observational study used the World Health Organization’s observation tool for studying hand hygiene indication and adherence: “My five moments for hand hygiene.” For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway.ResultsThe overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them.ConclusionsHand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers’ knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

Is it feasible to use a humanoid robot to promote hand hygiene adherence in a hospital setting?

SummaryHealthcare associated infections (HCAI) are a prevalent preventable cause of morbidity and mortality. Improving hand hygiene adherence is important for HCAI prevention. In this feasibility study, the objective was to determine if a humanoid robot could act as a novel single reminder intervention to improve hand hygiene adherence in a hospital setting. DAVE, a social humanoid robot, improved hand hygiene adherence at the entrance to a tertiary hospital and outpatient department, which was low at baseline, by 29%. DAVE shows promise as a novel intervention to improve hand hygiene adherence.

Pitfalls of a Staged Implementation of an Automated Hand Hygiene System: Lessons Learned

Background: Hand hygiene is the first defense against healthcare-associated infections, yet studies show that adherence to hand hygiene still remains low. An academic medical center selected a beacon-based automated hand hygiene reminder system to improve hand hygiene adherence. Accountability is challenging to enforce without a reliable means to measure hand hygiene adherence. The hospital used secret shoppers to observe hand hygiene adherence. This method captures an estimated 0.5%–1.7% of opportunities and may be influenced by the Hawthorne effect. Methods: In November 2018, a phased trial of an electronic hand hygiene reminder system began in 4 intensive care units (ICUs). The system selected used a badge and beacon technology. The badge identifies each care provider and displays colored lights to show adherence status. Beacons are present on the patient’s bed, soap, and hand sanitizer dispenser. These beacons establish a “patient zone” that captures opportunities for hand hygiene. The specialty beds in the ICUs were supposed to remain on the units. A patient transferring to a lower level of care would be placed on another bed or gurney when leaving the ICU. ICU staff were badged for the system. Results: The phased implementation strategy had challenges with beds, badges, and the system. Despite planning, education, and communication, the beds left the ICU area, so the beaconed beds were outside the ICU, and staff did not always wear their assigned badge. There were issues with the system router as well. Unit leadership and the infection control team worked on processes to get beds back into the units. The implementation team decided to provide badges to staff who regularly worked in the ICU to differentiate from consultation groups that came to the ICU (and were not badged). The system routers were plugged in at various places on the units and had become unplugged so information was not sent for reports. Despite these issues, over the year of implementation, the units did achieve an increase in hand hygiene adherence from 48% to 85%. Collectively, the units achieved a 53% reduction in central-line–associated blood stream infection (CLABSI), reducing infections from 13 to 7 and a 35% reduction in methicillin-resistant Staphylococcus aureus (MRSA), reducing infections from 8 to 3 as defined by the NHSN. Conclusions: When implementing a beacon-based, automated hand hygiene system, staged implementation can be challenging. To avoid these challenges, facility-wide implementation is preferable.Funding: NoneDisclosures: None

Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan.

Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.

Controlling nosocomial infection in adult intensive treatment unit: A quality improvement project.

Nosocomial infection is a significant burden on healthcare facilities. Its multifactorial nature renders it challenging to control. However, quality healthcare necessitates a safer service that poses no harm to the patient. The aim of this project was to reduce the infection rates in the adult ITU to the benchmark levels. We conducted an internal audit as a result of the high infection rates in the adult ITU. The audit started with root cause analysis using the fishbone quality tool. FOCUS-PDCA quality tool was used to design the framework. We introduced a change in the staff uniform laundry and organized a campaign to improve hand hygiene compliance using a multimodality approach. Moreover, we conducted training on aseptic techniques in ventilation, urinary catheter, and central lines insertion. Finally, we changed the ventilator filter to a higher quality brand which meets the standard specifications. Infection rates were monitored before and after the proposed changes. There was a marked reduction in ventilator-associated pneumonia; however, it did not reach the benchmark rates. Catheter line-associated bloodstream infection declined from above to below the benchmark. Catheter-associated urinary tract infection rates were below the benchmark; however, they showed a noticeable reduction. Hand hygiene adherence showed an improvement from 80% to 84%. However, this was below the predetermined target level of 90%. In-hospital laundry of staff uniforms is safer to control nosocomial infections. A multimodal approach is necessary to improve hand hygiene adherence and adoption of aseptic techniques. Quality improvement is a continuous process.

A higiene das mãos num serviço de pediatria

Introduction: Hand hygiene is a simple and effective intervention in breaking the chain of infection transmission. Objetive: To understand nurses’ perception on hand hygiene of nurses, children and their caregivers, in a pediatric unit. Methods: A descriptive study, framed in the qualitative paradigm was conducted. The data were obtained by semi-structured interview and their analysis using the Bardin content analysis method. A sample of 15 nurses was recruited from a pediatric inpatient service. Participants were mostly female, with an average age of 37.5 years. Results: Two categories emerged from the discourse analysis: conditioning factors of hand hygiene adherence, with subcategories related to nurses (four), children (four); and the caregivers (five); and strategies to improve hand hygiene adherence and its subcategories related to nurses (four); children and their caregivers (three). Conclusion: It is cruicial to raise awareness and training the teams and users of health units for this problem and how to minimize it. The planning of multimodal interventions to promote hand hygiene in a paediatric context emerges as a determining factor to optimize this practice.

What Psychological Theories of Behavior Change Can Teach Us about Improving Hand Hygiene Adherence: Do We Mean What We Say?

BackgroundHealth care worker (HCW) hand hygiene is effective in reducing healthcare associated infections, yet hand hygiene rates are suboptimal. Psychological theories of behavior change can be used to improve and sustain hand hygiene adherence. While past research has examined HCW explicit attitudes towards hand hygiene (ie., self-reported attitudes), it is unclear if these explicit attitudes are consistent with implicit attitudes (ie., attitudes outside of one’s awareness). Understanding HCW explicit and implicit attitudes is important when designing effective interventions to improve hand hygiene rates. This study examined explicit attitudes towards HCW hand hygiene and compared these to implicit attitudes.MethodsHCWs (N = 420) from 70 long-term care facilities in Ontario, Canada completed: (1) a survey tool based on psychological theories of behavior change to examine explicit attitudes towards hand hygiene, and (2) a computer administered implicit association test (IAT) and affect misattribution procedure (AMP) to evaluate implicit attitudes towards hand hygiene. Sociodemographics and self-reported hand hygiene adherence were measured. Factor analysis was performed to identify themes. Correlations were conducted between explicit and implicit measures.ResultsFactor analysis identified key explicit attitudes themes: (1) beliefs about consequences to self and others, (2) environmental resources, (3) time pressure and workload, and (4) social/professional role and identity. AMP and IAT results indicated that these procedures can be successfully applied to hand hygiene. While results suggested implicit positive attitudes towards hand hygiene, implicit test scores were neither correlated with explicit attitudes nor with self-reported hand hygiene adherence.ConclusionExplicit attitudes did not predict implicit attitudes. So, what we say is not always what we really think or do. Interventions have successfully targeted implicit attitudes to foster behavior change when targeting explicit attitudes alone did not work. This is yet to be explored in the hand hygiene arena, and is a key area for future research in order to guide the development of successful interventions to sustainably improve hand hygiene rates.Disclosures All authors: No reported disclosures.

Use of a patient empowerment tool for hand hygiene

Patient empowerment is recognized as an important component of a multimodal strategy to improve hand hygiene adherence. We examined the attitudes of adult patients and parents of pediatric patients toward a new patient empowerment tool (PET) at our hospital. We also surveyed physicians to determine their perceptions about the PET. A cross-sectional survey was performed of hospitalized children's parents and adult patients in a 531-bed tertiary care teaching hospital in West Virginia. Surveys were anonymous and self-administered. A separate survey was administered via e-mail to resident and attending physicians from the departments of internal medicine, pediatrics, and family medicine. Most parents and adult patients felt it was their role to speak up if a provider did not perform hand hygiene, but a smaller number actually felt comfortable using the PET. Only 54.9% of physicians felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient to use words rather than the PET to remind them to perform hand hygiene. In our study, parents and adult patients supported use of the PET, but physicians were less supportive. As the patient empowerment movement grows, we should work to improve physician acceptance of patient involvement if it is to be successful.

Smartphone text message service to foster hand hygiene compliance in health care workers.

Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence. The study is a historical comparison proof-of-concept study. Eighteen health care workers were monitored during 12 months by a radiofrequency identification system. Afterward we sent 2 types of text messages, congratulation or encouragement, and we studied the evolution of hand hygiene adherence. We recorded 15,723 hand hygiene opportunities, 8,973 before intervention and 6,750 during and after the intervention. Using a multilevel logistic regression analysis, we found a significant increase in hand hygiene adherence during the intervention (odds ratio, 1.68) compared with the historical period. Despite limitations due to the type of study, a text message encouraging personnel to be more vigilant is effective in increasing hand hygiene adherence in health care workers. Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.

5-146 - An Internet-based Learning and Stage-matched Message Intervention to Improve Hand Hygiene Adherence Among Healthcare Workers in Guatemala

5-146 - An Internet-based Learning and Stage-matched Message Intervention to Improve Hand Hygiene Adherence Among Healthcare Workers in Guatemala

Implementation of an innovative hands-on training to improve adherence to hygiene rules: A feasibility Study

Hospital-acquired infections (HAI) still pose a major problem in inpatient care. The single most important measure for preventing HAIs is to improve adherence to hand hygiene among health care professionals. To assess the feasibility of an innovative hands-on training to improve adherence to hygiene rules under standardized and under real life conditions. Before-after controlled cohort trial to assess the feasibility of implementing an innovative hands-on training to improve hand hygiene adherence. Large university hospital in Germany. Fifty trained nurses from three wards with an average age of 32years (±10.22years) and an average vocational experience of 6.85years (±7.54years). The intervention consisted of a hands-on training in the skills lab of the University of Cologne complemented by a 12-week observation period before and after the training on participating wards. The training comprised important skills with respect to hand hygiene, venipuncture, dressing changes of central venous catheters, preparation of IV infusions, and donning of gloves using sterile technique. A communication training was included to enable nurses to enforce hygiene rules in their collaboration with peers and physicians. The intervention was taught in small groups with a wide array of interactive teaching methods. It was evaluated using the objective structured clinical examination (OSCE) format. Observations were conducted by a trained infection control nurse. Before (after) the intervention 622 (612) occasions of hand hygiene were documented. A highly significant improvement in hygiene compliance was observed pre- and post-intervention (64.3% vs. 79.2%; p≤0.0001). The OSCE evaluation showed significant improvements in all subscales. The developed and conducted hands-on training seems feasible and is successful in significantly improving adherence to hygiene rules under standardized and real life conditions. Whether the effect is stable over time is subject to further investigation.

Behavior-based interventions to improve hand hygiene adherence among intensive care unit healthcare workers in Thailand.

To evaluate behavioral-based interventions to improve hand hygiene (HH) among healthcare workers (HCWs) at a Thai tertiary care center. A quasi-experimental study was performed in 6 intensive care units with computer-generated allocation. Baseline demographic characteristics, self-reported stage of HH behavioral commitment, and observed HH adherence were examined from January 1, 2012, through December 31, 2012 (preintervention), and from January 1, 2013, through December 31, 2013 (postintervention). Self-reported HH was categorized by the stages construct from the Transtheoretical Model of Health Behavior Change. The intensive care unit group randomization was to either standard-of-care HH education every 3 months (S1), intensified HH interventions (S2), or intensified HH interventions plus increased availability of alcohol-based handrub throughout the unit (S3). Among 125 HCWs from 6 intensive care units (42 in S1, 41 in S2, 42 in S3) there were 1,936 total HH observations; most HCWs (100 [ 80%]) were nurses or nurse assistants. Compared with preintervention, overall postintervention HH adherence improved in HCWs assigned to S2 (65% vs 85%; P=.02) and S3 (66% vs 95%; P=.005) but not S1 (68% vs 71%; P=.84). Improvement in HH adherence was demonstrated among HCWs who reported lower stages of HH commitment in S2 (21% vs 84%; P<.001) and S3 (24% vs 89%; P<.001) and in HCWs who self-reported higher stages of commitment in S3 (78% vs 96%; P<.001). HCW HH programs may benefit from stage-based tailored strategies to promote sustained HH adherence.

Translational Research in Hand Hygiene Compliance

Hand hygiene is considered to be the most important measure to prevent healthcare-associated infections, which represent a big concern in the world and are considered as priority by the World Health Organization, which proposed a multimodal strategy that has been implemented in several settings. However, many studies demonstrate that the overall compliance for hand hygiene practice remains low, and the most effective strategy or group of strategies are still unclear. We reviewed original articles reporting implemented strategies in order to improve hand hygiene adherence rates in healthcare services published in the last 2 years. Educational measures (like training, e-learning modules, feedback, and reminders), behavioral methods, electronic, radiofrequency and ultrasound methods, and patient empowerment strategies are discussed. We also discuss actions implemented in low-income countries where resources are limited. Most of the approaches presented in this article demonstrate they are effective in increasing hand hygiene adherence rates; on the other hand, sustainability of the results is difficult to achieve and vary according to local culture and resources. Although most of the reviewed articles are before-and-after studies and there is a paucity of high-quality studies, it seems that multimodal, continued interventions, and culture changes are essential to sustain high hand hygiene compliance rates.

1514Targeting Behaviors Using Transtheoretical Model To Improve Hand Hygiene Adherence Among Intensive Care Unit Healthcare Workers

1514Targeting Behaviors Using Transtheoretical Model To Improve Hand Hygiene Adherence Among Intensive Care Unit Healthcare Workers

Do peer effects improve hand hygiene adherence among healthcare workers?

To determine whether hand hygiene adherence is influenced by peer effects and, specifically, whether the presence and proximity of other healthcare workers has a positive effect on hand hygiene adherence. An observational study using a sensor network. A 20-bed medical intensive care unit at a large university hospital. Hospital staff assigned to the medical intensive care unit. We deployed a custom-built, automated, hand hygiene monitoring system that can (1) detect whether a healthcare worker has practiced hand hygiene on entering and exiting a patient's room and (2) estimate the location of other healthcare workers with respect to each healthcare worker exiting or entering a room. We identified a total of 47,694 in-room and out-of-room hand hygiene opportunities during the 10-day study period. When a worker was alone (no recent healthcare worker contacts), the observed adherence rate was 20.85% (95% confidence interval [CI], 19.78%-21.92%). In contrast, when other healthcare workers were present, observed adherence was 27.90% (95% CI, 27.48%-28.33%). This absolute increase was statistically significant (P < .01). We also found that adherence increased with the number of nearby healthcare workers but at a decreasing rate. These results were consistent at different times of day, for different measures of social context, and after controlling for possible confounding factors. The presence and proximity of other healthcare workers is associated with higher hand hygiene rates. Furthermore, our results also indicate that rates increase as the social environment becomes more crowded, but with diminishing marginal returns.