Effectiveness over time of a multimodal intervention to improve compliance with standard hygiene precautions in an intensive care unit of a large teaching hospital

Abstract

Background: Standard hygiene precautions are an effective way of controlling healthcare-associated infections. Nevertheless, compliance with hand hygiene (HH) guidelines among healthcare workers (HCWs) is often poor, and evidence regarding appropriate use of gloves and gowns is limited and not encouraging. In this study, we evaluated the ability over time of a multimodal intervention to improve HCWs compliance with standard hygiene precautions.

Methods: Trend analysis of direct observations of compliance with HH guidelines and proper glove or gown use was conducted in the medical/surgical intensive care unit (ICU) of Umberto I Teaching Hospital of Sapienza University of Rome. The study consisted of two phases: a six-month baseline phase and a 12-month post-intervention phase. The multimodal intervention was based on the World Health Organization strategy and included education and training of HCWs, together with performance feedback.

Results: A total of 12,853 observations were collected from November 2016 to April 2018. Overall compliance significantly improved from 41.9% at baseline to 62.1% (p < 0.001) after the intervention and this improvement was sustained over the following trimesters. Despite variability across job categories and over the study period, a similar trend was observed for most investigations. The main determinants of compliance were job category (with nurses having the highest compliance rates), being a member of ICU staff and whether delivering routine, as opposed to emergency, care. HH compliance was modified by glove use; unnecessary gloving negatively affected HH behaviour while appropriate gloving positively influenced it.

Conclusions: The multimodal intervention resulted in a significant improvement in compliance with standard hygiene precautions. However, regular educational reinforcement and feedback is essential to maintain a high and uniform level of compliance.

Keywords: Compliance; Infection control; Standard hygiene precautions; WHO multimodal strategy.

Fig. 1

Compliance with standard hygiene precautions over the study period in the intensive care unit of Umberto I Teaching Hospital of Sapienza University of Rome. Results are shown in terms of overall compliance, compliance with hand hygiene (HH) guidelines and compliance with proper glove or gown use over six trimesters (a) and in terms of overall compliance in the joinpoint regression (b)

Fig. 2

Compliance with standard hygiene precautions over the study period in the intensive care unit of Umberto I Teaching Hospital of Sapienza University of Rome. Results are shown in terms of compliance with hand hygiene guidelines over six trimesters by interaction type (a) and in terms of compliance with proper glove or gown use over six trimesters by category (b)