Education alone does not improve hand hygiene

Does education alone improve handwashing compliance among healthcare workers in a hospital setting?

According to the study that I discuss below, the short answer to the above question appears to be no.

However, this study has adopted a before-after intervention design without a control group. The more accurate interpretation should be that education/feedback intervention alone is inadequate to improve handwashing compliance significantly.

Setting Two ICUs and one general medical ward in a US hospital
Target audienceAll healthcare workers
Study design Before-after intervention /observational study
Intervention Six in-service education/feedback intervention per each
Main outcome measure Direct observation of handwashing randomized for the
time of the day and bed location
Findings No statistically significant change in handwashing rates
Conclusion The introduction of education/feedback was not associated with significant higher rates of handwashing compliance.
Journal referenceApril 10, 2000, JAMA NETWORK;
Accessfree access to the full article

This was only one component of a bigger study in which alcohol-based hand sanitizer was introduced. It came out with a statistically significant improvement in compliance. I discussed it in another post.

Furthermore, a systematic review of 19 systematic reviews of hand hygiene compliance found that the interventions that address social influence, attitudes, self-efficacy, and intentions improve compliance significantly. In other words, the interventions should be grounded on behavior change theories.

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