Infection Control & Hospital Epidemiology
Table 3. Hand Hygiene Compliance Change Over Time Per Healthcare Time Point 1
Correct
Organization Healthcare
organization 1 Healthcare organization 2 Healthcare organization 3 Healthcare organization 4 Healthcare organization 5 Healthcare organization 6 Healthcare organization 7 Healthcare organization 8 Healthcare organization 9 Healthcare organization 10 aSignificant if P<.05 in χ2 analysis.
a review, Gould et al18 and Luangasanatip et al25 showed that hand hygiene compliance increased and HAI decreased with different types of interventions. Furthermore, performance feedback was associated with increased hand hygiene compliance. Concerning the wards, Fuller et al26 showed an increase in compliance of 10% (P<.01) on intensive care wards in a feedback intervention trial with baseline compliance of 70%.26 This finding is in line with the increase of 11.4% on the intensive care ward in our present study. Other literature suggests that nurses usually have a higher compliance rate than physicians.10 Moro et al27 investigated hand
intervals, following the WHO Five Moments of Hand Hygiene. The results of this study suggest that implementation of a multi- modal intervention program framed within a friendly competition setting can increase hand hygiene compliance in healthcare orga- nizations. Comparing time point 1 with time point 5, an overall increase of 8.5% in hand hygiene compliance occurred across all healthcare organizations, with large variations among the organi- zations (−11.5% to +33.3%). Hand hygiene compliance also dif- fered between ward type and type of HCW, resulting in a low overall increase in compliance on the surgical wards (6.9%) but a much greater increase on the gynecology-obstetric wards (20.5%). The neonatal ward in the current study showed the highest odds (OR, 3.96; 95% CI, 2.99–5.25) of being compliant in the multi- variable analysis. At the same time, hand hygiene compliance in the neonatal ward decreased significantly by 22.1% between time points 1 and 5. This finding can be explained by the fact that hand hygiene compliance rates between time points 1 and 5 are very different, but the average hand hygiene compliance of all the 5 time points together is still high. These findings are in line with other studies in the literature. In
hygiene compliance between nurses, physicians, auxiliary staff, and other HCWs. They studied the effect of a national multi- modal “Clean Care is Safer Care” campaign for hand hygiene in 65 hospitals in Italy. The hand hygiene compliance of nurses increased by 25% compared to an increase of 16% among phy- sicians.27 In the present study, nurses showed greater improve- ment in hand hygiene compliance than physicians. The hand hygiene compliance of nurses increased significantly by 9.2% (P<.001) between time points 1 and 5. This finding contrasts with the compliance rate of physicians, which showed no sig- nificant change in the same period. Possibly, nurses were targeted more specifically by the interventions executed in their organi- zation, for example, through team training on the ward. This study has a number of strengths and limitations. First, organizations were able to choose the intervention they wanted to implement. In addition to monitoring and feedback of achieve- ments at 6-month intervals, they also chose their own interven- tions outside the study setting. Therefore, the results reflect the effects of usual improvement activities together with the effect of being part of a study. Although this might make the data less compelling from a scientific point of view, the conclusion remains that improvement is achievable for hospitals implementing interventions on their own, which is a major strength of this study. Another strength is the fact that the hand hygiene obser- vations were not a burden to the HCWs. The HCW participants followed their normal work routines and were observed by unobtrusive observers without interrupting the care processes. All observers followed HCWs during their tasks, (and after consent from the patient) even behind curtains and during washing/ showering, etc. This method yielded a true cross section of hand
138 401 34.4 202 470 43.0 .010a 8.6 42 107 39.3 78 129 60.5 .001a 21.2 123 541 22.7 266 606 43.9 <.001a 21.2 14 65 21.5 51 93 54.8 <.001a 33.3 47 76 61.8 164 221 74.2 .040a 12.4 182 410 44.4 171 437 39.1 .121 − 5.3 227 433 52.4 189 366 51.6 .825 − 0.8 104 242 43.0 112 228 49.1 .181 6.1 50 101 49.5 81 213 38.0 .054 − 11.5
Opportunities 913
Total
Opportunities 1,909
%
Compliance 47.8
Correct
Opportunities 808
191
Time Point 5 Total
Opportunities 1,368
%
Compliance 59.1
P Value of Change
<.001a %
Change 11.2
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