Hand hygiene compliance improves during Dutch 'competition'

26th of February 2019
Hand hygiene compliance improves during Dutch 'competition'

Overall hand hygiene compliance increased during a two-year "friendly competition" in the Netherlands in which staff at 10 healthcare facilities were observed and ranked based on their compliance, according to researchers.Hand hygiene among health care workers is generally poor and many studies have assessed different interventions to improve it.

Writing in Infection Control & Hospital Epidemiology, Manon van Dijk, junior researcher in the department of medical microbiology and infectious diseases at Erasmus University Medical Center in Rotterdam, and colleagues noted that hand hygiene behaviour among healthcare workers is "strongly associated" with the prevalence of healthcare associated infections.

Van Dijk reported that in 2014 nine hospitals and one rehabilitation centre in Rotterdam started "Roll Up Your Sleeves," a WHO multimodal regional intervention strategy overseen by the Collaborating Rijnmond Hospitals programme. Trained observers inspected hand hygiene compliance on different wards and among different healthcare workers at five time points from May 2014 to September 2016.

The programme consisted of monitoring and feedback of compliance with the WHO Five Moments of Hand Hygiene, examined at six-month intervals over the two-year study period. There also were optional training elements, such as individual e-learning, a kick-off workshop, observer training and team training.

Compliance was reported as a ranking, and the programme leaders within each organisation were given the results of each observation to share among staff, van Dijk and colleagues explained.

Overall 20,286 hand hygiene opportunities were observed in 120 hospital wards. At first measure the overall mean hand hygiene compliance was 42.9 per cent. At the fifth and final time point, this increased to 51.4 per cent. Between the two time points, compliance among physicians and other health care workers remained unchanged, whereas compliance among nurses showed significant improvement of 9.2 per cent.

Statistical modeling showed a significant association with compliance by time points, type of ward and type of healthcare worker. Specifically there was an overall 6.9 per cent increase in compliance on the surgical wards compared with a 20.5 per cent increase on the gynecology-obstetric wards. Additionally, the researchers observed that workers on the neonatal ward had the highest OR of being compliant, although compliance decreased significantly by 22.1 per cent between time points one and five.

"Our results show that the multimodal intervention program of ‘Roll Up Your Sleeves' in a friendly competition setting was accompanied by a significant overall increase of hand hygiene compliance between the start and the end of the programme," van Dijk and colleagues wrote.

"Future research is needed to investigate the longterm effects of the intervention program and how the element of competition could be further applied to promote hand hygiene compliance."



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