Posted in Infection control research

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
unit
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; https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485276?resultClick=1
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.

Posted in #covid-19 Infection control research

Alcohol sanitizers and hand hygiene compliance

Hand hygiene has become nowadays one of the most heard behavioral activities. It is one of the most effective actions we should do to prevent the spread of the COVID 19 virus. Therefore alcohol hand sanitizers are an essential commodity.

The healthcare workers are not an exception.

However, adherence to cleaning hands with 70 percent alcohol hand sanitizers by healthcare workers requires promotion.

Simply, alcohol hand sanitizers should be made accessible at hand whenever necessary, most of the time at bedside of patients in hospitals.

Does alcohol-based hand rub sanitizers, when accessible, improve hand hygiene compliance among healthcare workers?

The answer is yes.

Setting Two ICUs and one general medical ward in a US hospital
Target audienceAll healthcare workers
Study design Six-month observational study
Intervention One sanitizer per 4 bedsides initially and then one per
each bedside was introduced.
Main outcome measure Direct observation of handwashing randomized for the
time of the day and bed location
Findings The compliance rates improved from 19% to 41% with
1 dispenser per 4 beds and from 23% to 48%
with 1 dispenser for each bed.
Conclusion The introduction of sanitizers is associated with higher
rates of handwashing compliance.
Journal referenceApril 10, 2000, JAMA NETWORK; https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485276?resultClick=1
Accessfree access to the full article

However, the finding is from an observational study.

Posted in Infection control research

Handwashing signage at point-of-use

Is reminder signage at point-of-use to promote handwashing for hospital healthcare workers effective?

The conclusion is No.

Setting acute care hospitals in the US
Target audienceall healthcare workers
Number of units involved58 in-patient units in 9 hospitals
Methodcluster-randomized clinical trial; units were randomly assigned to (1) no change; (2) weekly change; and (3) monthly change.
Intervention reminder signs were placed next to Alcohol-based dispensers
Assessment covert observation at entry and exit points to patients’
rooms
Conclusion no statistically significant effect
Interpretation Nudging by changing signs did not influence
hand hygiene practices.
Journal referenceOctober 23, 2019. doi:10.1001/jamanetworkopen.2019.13823
Accessfree access to the whole paper
hand washing
Posted in Infection control research

Research on health workers’ hand hygiene compliance promotion:1

During this unprecedented COVID 19 pandemic, healthcare workers are one of the most vulnerable high-risk groups who have been contracting the virus, second only to the seniors living in long-term care facilities.

In this background, I looked at the existing evidence about one crucial aspect in the prevention and control of spreading the virus: healthcare workers’ hand hygiene.

During my exploration, I found a systematic review of systematic reviews published in 2018.

A systematic review of systematic reviews – 2018

As anyone can guess, there has been a large number of research available in the world for someone to conduct a systematic review of systematic reviews.

This review has looked at 19 systematic reviews published between 2001 to 2017. Of these, 13 reviews included hospital-based primary studies. In addition to the hospitals, the rest has looked at studies from long-term and other care facilities. Before going further, I would like to highlight that only study, according to their review criteria, had low-risk of bias.

Findings

They have found that;

  • the interventions that targeted social influence, attitudes, self-efficacy, and intention were associated with greater effectiveness.
  • no clear association between the delivery method of the intervention and its effectiveness.

The interventions targeting social influence, attitudes, self-efficacy, and intention were associated with greater effectiveness

Price, L., MacDonald, J., Gozdzielewska, L., Howe, T., Flowers, P., Shepherd, L., . . . Reilly, J. (2018). Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews. Infection Control & Hospital Epidemiology, 39(12), 1449-1456. doi:10.1017/ice.2018.262:https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/interventions-to-improve-healthcare-workers-hand-hygiene-compliance-a-systematic-review-of-systematic-reviews/F340A30ADE35391B7529CD3B581D7BBE

Conclusions

It seems clear that the interventions work. However, there are several caveats; no adequate evidence about the nature of the content, delivery method, and monitoring strategies.

Recommendations

Future research should rigorously apply behavior change theories; the interventions should be long-term and adopt strong study designs with clearly defined outcomes.

Those who are interested to read the full report, here is the link: https://www.researchgate.net/publication/329577771_Interventions_to_improve_healthcare_workers’_hand_hygiene_compliance_A_systematic_review_of_systematic_reviews