In the JournalsPerspective

‘Friendly competition’ between hospitals improves hand hygiene

Overall hand hygiene compliance increased during a 2-year “friendly competition” in the Netherlands in which staff at 10 health care centers were observed and ranked based on their compliance, according to researchers.

Hand hygiene among health care workers is poor, with a recent study highlighting low compliance among EMS workers. Another study cited glove use as a potential barrier to hand hygiene among nurses, and many studies have assessed different interventions — such as badges that display your compliance and reducing the amount of hand-washing steps — to improve hand hygiene.

Writing in Infection Control & Hospital Epidemiology, Manon D. van Dijk, MSc, junior researcher in the department of medical microbiology and infectious diseases at Erasmus University Medical Center in Rotterdam, and colleagues noted that hand hygiene behavior among health care workers is “strongly associated” with the prevalence of health care-associated infections.

“An effective and recommended solution to prevent transmission of microorganisms is improving hand hygiene compliance in health care organizations,” they wrote.

Handwashing 
A friendly competition between hospitals increased hand hygiene compliance among health care workers.
Source: Adobe Stock

According to van Dijk and colleagues, in 2014, nine hospitals and one rehabilitation center in Rotterdam started “Roll Up Your Sleeves,” a WHO multimodal regional intervention strategy overseen by the “Collaborating Rijnmond Hospitals” program. Trained observers inspected hand hygiene compliance on different wards and among different health care workers at five time points from May 2014 to September 2016.

The program consisted of monitoring and feedback of compliance with the WHO Five Moments of Hand Hygiene, examined at 6-month intervals over the 2-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 program leaders within each organization 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% (95% CI, 41.4-44.4). At the fifth and final time point, this increased to 51.4% (95% CI, 49.8-53). 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% (P < .001).

Statistical modeling showed a significant association with compliance by time points, type of ward and type of health care worker. Specifically, there was an overall 6.9% increase in compliance on the surgical wards compared with a 20.5% increase on the gynecology-obstetric wards. Additionally, the researchers observed that workers on the neonatal ward had the highest OR of being compliant (OR = 3.96; 95% CI, 2.99-5.25), although compliance decreased significantly by 22.1% 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 program,” van Dijk and colleagues wrote. “Future research is needed to investigate the long-term effects of the intervention program and how the element of competition could be further applied to promote hand hygiene compliance.” – by Marley Ghizzone

Disclosures: The authors report no relevant financials disclosures.

Overall hand hygiene compliance increased during a 2-year “friendly competition” in the Netherlands in which staff at 10 health care centers were observed and ranked based on their compliance, according to researchers.

Hand hygiene among health care workers is poor, with a recent study highlighting low compliance among EMS workers. Another study cited glove use as a potential barrier to hand hygiene among nurses, and many studies have assessed different interventions — such as badges that display your compliance and reducing the amount of hand-washing steps — to improve hand hygiene.

Writing in Infection Control & Hospital Epidemiology, Manon D. van Dijk, MSc, junior researcher in the department of medical microbiology and infectious diseases at Erasmus University Medical Center in Rotterdam, and colleagues noted that hand hygiene behavior among health care workers is “strongly associated” with the prevalence of health care-associated infections.

“An effective and recommended solution to prevent transmission of microorganisms is improving hand hygiene compliance in health care organizations,” they wrote.

Handwashing 
A friendly competition between hospitals increased hand hygiene compliance among health care workers.
Source: Adobe Stock

According to van Dijk and colleagues, in 2014, nine hospitals and one rehabilitation center in Rotterdam started “Roll Up Your Sleeves,” a WHO multimodal regional intervention strategy overseen by the “Collaborating Rijnmond Hospitals” program. Trained observers inspected hand hygiene compliance on different wards and among different health care workers at five time points from May 2014 to September 2016.

The program consisted of monitoring and feedback of compliance with the WHO Five Moments of Hand Hygiene, examined at 6-month intervals over the 2-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 program leaders within each organization 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% (95% CI, 41.4-44.4). At the fifth and final time point, this increased to 51.4% (95% CI, 49.8-53). 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% (P < .001).

Statistical modeling showed a significant association with compliance by time points, type of ward and type of health care worker. Specifically, there was an overall 6.9% increase in compliance on the surgical wards compared with a 20.5% increase on the gynecology-obstetric wards. Additionally, the researchers observed that workers on the neonatal ward had the highest OR of being compliant (OR = 3.96; 95% CI, 2.99-5.25), although compliance decreased significantly by 22.1% 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 program,” van Dijk and colleagues wrote. “Future research is needed to investigate the long-term effects of the intervention program and how the element of competition could be further applied to promote hand hygiene compliance.” – by Marley Ghizzone

Disclosures: The authors report no relevant financials disclosures.

    Perspective
    Heidi Storm Vikke

    Heidi Storm Vikke

    It is alarming that hand hygiene compliance among various health care workers is poor, despite the fact that it is essential in preventing infection. I find it hard to comprehend how it can be neglected when we as health care workers are obliged to protect and care for our patients. Why do we thus not protect them against infections?

    Hand hygiene is not rocket science; it is quite easy to conduct. However, improving a poor hand hygiene compliance has proven very complicated. WHO recommends multimodal approaches when improving hand hygiene, and focus should comprise both the organizational and the individual aspects.

    Therefore, it is essential to gain knowledge about organizational and individual challenges before planning and executing improvement strategies. Some interventions have an impact in one setting but not in others. In fact, merely putting hand hygiene on the agenda may improve compliance. So, what do we do to empower our strategies?

    I believe that we should manifest hand hygiene’s importance on all levels in an organization, from management to workers. In other words, it must be a natural part of our patient safety agenda.

    Also, continuing training, using immediate feedback opportunities, and providing access to hand hygiene supplies should be considered a minimum. Furthermore, by applying behavioral theories, we can investigate hand hygiene perception among health care workers and, thus, elucidate obstacles and plan sustainable solutions. 

    • Heidi Storm Vikke, RN, MSc
    • PhD student
      Falck Danmark A/S
      Department of clinical research, University of Southern Denmark

    Disclosures: Vikke reports no relevant financial disclosure.