A qualitative study of senior hospital managers’ views on current and innovative strategies to improve hand hygiene

Background: In 2009, the National Hand Hygiene Initiative (NHHI) was implemented in hospitals across Australia with the aim of improving hand hygiene practices and reducing healthcare-associated infections. Audits conducted post-implementation showed the lowest rates of compliance with hand hygiene practices are among operational staff including hospital cleaners. There is limited information about hand hygiene issues in hospital cleaners to inform development of evidence-based interventions to improve hand hygiene compliance in this group. Aim: This qualitative study was undertaken to explore the attitudes of hospital cleaning staff regarding hand hygiene and the National Hand Hygiene Initiative. Methodology: Focus groups were conducted with 12 cleaning staff at a large Australian hospital implementing the National Hand Hygiene Initiative. Findings: Hospital cleaners recognise the importance of hand hygiene in preventing healthcare-associated infections. Cleaners cite peer support, leadership, and the recognition and reward of those excelling in hand hygiene as strong motivators. Barriers to optimal hand hygiene practice include the presence of multiple conflicting guidelines, hand hygiene “overload” and a lack of contextualised education programs. This exploratory qualitative study reveals three themes about attitudes of hospital cleaning staff towards hand hygiene. These themes are: (1) “The culture of hand hygiene: It’s drummed into us”; (2) “Reminders and promotion for hand hygiene: We just need a big ‘Please wash your hands’ sign”; and (3) “The personal value of hand hygiene: Like he said, it’s second nature to us”. Conclusion: Hand-hygiene messages and training need to be more consistent and contextualised to achieve improvements in hand hygiene practices in hospital cleaning staff in Australia.

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CleanHands Sensor Based System to Improve Hand Hygiene and Reduce Infection

Case Medical Research ◽

10.31525/ct1-nct03948672 ◽

2019 ◽

Author(s):

Keyword(s):

Hand Hygiene ◽

Improve Hand Hygiene

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Utilizing Academic–Community Partnerships With Nursing Students to Improve Hand Hygiene in Elementary Students to Reduce Transmission of COVID-19

NASN School Nurse ◽

10.1177/1942602x20986958 ◽

2021 ◽

pp. 1942602X2098695

Author(s):

Julie Perry ◽

Natasha McClure ◽

Rebecca Palmer ◽

Jeremy L. Neal

Keyword(s):

Health Promotion ◽

Nursing Students ◽

Hand Hygiene ◽

Nursing Student ◽

School Health ◽

Community Partnerships ◽

School Nurses ◽

Academic Community ◽

Health Staff ◽

Improve Hand Hygiene

Coronavirus disease 2019 (COVID-19) has raised awareness about the vital role school nurses have in improving the overall health of children. School nurses provide health promotion within schools, yet over 60% of schools have only a part-time nurse or no nurse. Nursing students may be valuable partners for health promotion and academic–community partnerships may be mutually beneficial to schools of nursing and local schools. Using a nursing student team to teach hand hygiene while school health staff were present provided an opportunity for hands-on training to help the staff master curriculum content and ensure competency. This article describes a collaborative partnership initiative that expanded access to health promotion education in schools to increase knowledge about reducing the spread of infectious disease, such as COVID-19, while providing valuable clinical experiences for nursing students.

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Improving hand hygiene in hospitals: comparing the effect of a nudge and a boost on protocol compliance

Behavioural Public Policy ◽

10.1017/bpp.2021.15 ◽

2021 ◽

pp. 1-23

Author(s):

Henrico van Roekel ◽

Joanne Reinhard ◽

Stephan Grimmelikhuijsen

Keyword(s):

Hand Hygiene ◽

Behavioral Interventions ◽

Hand Hygiene Compliance ◽

Hospital Nurses ◽

Improve Hand Hygiene ◽

Policy Practice ◽

Effective Interventions ◽

Risk Literacy ◽

Hygiene Compliance ◽

Hospital Wards

Abstract Nudging has become a well-known policy practice. Recently, ‘boosting’ has been suggested as an alternative to nudging. In contrast to nudges, boosts aim to empower individuals to exert their own agency to make decisions. This article is one of the first to compare a nudging and a boosting intervention, and it does so in a critical field setting: hand hygiene compliance of hospital nurses. During a 4-week quasi-experiment, we tested the effect of a reframing nudge and a risk literacy boost on hand hygiene compliance in three hospital wards. The results show that nudging and boosting were both effective interventions to improve hand hygiene compliance. A tentative finding is that, while the nudge had a stronger immediate effect, the boost effect remained stable for a week, even after the removal of the intervention. We conclude that, besides nudging, researchers and policymakers may consider boosting when they seek to implement or test behavioral interventions in domains such as healthcare.

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Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1130 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s457-s457

Author(s):

Mohammed Lamorde ◽

Matthew Lozier ◽

Maureen Kesande ◽

Patricia Akers ◽

Olive Tumuhairwe ◽

...

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Wide Distribution ◽

Patient Contact ◽

Improve Hand Hygiene ◽

Before And After ◽

Hygiene Compliance ◽

Handwashing With Soap

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan

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Interventions to improve hand hygiene compliance in patient care

10.1002/14651858.cd005186 ◽

2004 ◽

Cited By ~ 2

Author(s):

JH Chudleigh ◽

DJ Gould ◽

R Grol ◽

D Moralejo

Keyword(s):

Hand Hygiene ◽

Patient Care ◽

Hand Hygiene Compliance ◽

Improve Hand Hygiene ◽

Hygiene Compliance

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Psychomotor learning theory informing the design and evaluation of an interactive augmented reality hand hygiene training app for healthcare workers

Education and Information Technologies ◽

10.1007/s10639-021-10752-4 ◽

2021 ◽

Author(s):

Gerard Lacey ◽

Lucyna Gozdzielewska ◽

Kareena McAloney-Kocaman ◽

Jonathan Ruttle ◽

Sean Cronin ◽

...

Keyword(s):

Augmented Reality ◽

Hand Hygiene ◽

World Health Organisation ◽

World Health ◽

Psychomotor Skills ◽

Healthcare Organizations ◽

Improve Hand Hygiene ◽

Training Tool ◽

Independent Evaluation ◽

Skills Learning

AbstractHand hygiene is critical for infection control, but studies report poor transfer from training to practice. Hand hygiene training in hospitals typically involves one classroom session per year, but psychomotor skills require repetition and feedback for retention. We describe the design and independent evaluation of a mobile interactive augmented reality training tool for the World Health Organisation (WHO) hand hygiene technique. The design was based on a detailed analysis of the underlying educational theory relating to psychomotor skills learning. During the evaluation forty-seven subjects used AR hand hygiene training over 4 weeks. Hand hygiene proficiency was assessed at weekly intervals, both electronically and via human inspection. Thirty eight participants (81%) reached proficiency after 24.3 (SD = 17.8) two-minute practice sessions. The study demonstrated that interactive mobile applications could empower learners to develop hand hygiene skills independently. Healthcare organizations could improve hand hygiene quality by using self-directed skills-based training combined with regular ward-based assessments.

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