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Observational Study
. 2019 Feb;40(2):187-193.
doi: 10.1017/ice.2018.261.

A multimodal regional intervention strategy framed as friendly competition to improve hand hygiene compliance

Manon D van Dijk  1 , Sanne A Mulder  2 , Vicki Erasmus  2 , A H Elise van Beeck  2 , Joke M J J Vermeeren  3 , Xiaona Liu  2 , Ed F van Beeck  2 , Margreet C Vos  1
Affiliations
Observational Study

A multimodal regional intervention strategy framed as friendly competition to improve hand hygiene compliance

Manon D van Dijk et al. Infect Control Hosp Epidemiol. 2019 Feb.

Abstract

Objective: To investigate the effects of friendly competition on hand hygiene compliance as part of a multimodal intervention program.

Design: Prospective observational study in which the primary outcome was hand hygiene compliance. Differences were analyzed using the Pearson χ2 test. Odds ratios (ORs) with 95% confidence interval were calculated using multilevel logistic regression.

Setting: Observations were performed in 9 public hospitals and 1 rehabilitation center in Rotterdam, Netherlands.ParticipantsFrom 2014 to 2016, at 5 time points (at 6-month intervals) in 120 hospital wards, 20,286 hand hygiene opportunities were observed among physicians, nurses, and other healthcare workers (HCWs).InterventionThe multimodal, friendly competition intervention consisted of mandatory interventions: monitoring and feedback of hand hygiene compliance and optional interventions (ie, e-learning, kick-off workshop, observer training, and team training). Hand hygiene opportunities, as formulated by the World Health Organization (WHO), were unobtrusively observed at 5 time points by trained observers. Compliance data were presented to the healthcare organizations as a ranking.

Results: The overall mean hand hygiene compliance at time point 1 was 42.9% (95% confidence interval [CI], 41.4-44.4), which increased to 51.4% (95% CI, 49.8-53.0) at time point 5 (P<.001). Nurses showed a significant improvement between time points 1 and 5 (P<.001), whereas the compliance of physicians and other HCWs remained unchanged. In the multilevel logistic regressions, time points, type of ward, and type of HCW showed a significant association with compliance.

Conclusion: Between the start and the end of the multimodal intervention program in a friendly competition setting, overall hand hygiene compliance increased significantly.

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Figures

Fig. 1
Fig. 1
Overview of the study population, which illustrates a hierarchical overview with 3 levels: healthcare organizations, wards, and observed opportunities. Level 3 illustrates the number of observed opportunities that hand hygiene should have been applied.
Fig. 2
Fig. 2
Overview of the mean hand hygiene compliance per time point of the 10 healthcare organizations in combination with the implemented (optional) interventions.
See this image and copyright information in PMC

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