Features of educational interventions that lead to compliance with hand hygiene in healthcare professionals within a hospital care setting. A BEME systematic review: BEME Guide No. 22

AbstractObjectiveTo synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).MethodsPRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed.ResultsOverall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness.ConclusionsThis is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.

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Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis

BMC Medical Education ◽

10.1186/s12909-016-0653-x ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 53

Author(s):

Han-Oh Chung ◽

Simon J. W. Oczkowski ◽

Louise Hanvey ◽

Lawrence Mbuagbaw ◽

John J. You

Keyword(s):

Systematic Review ◽

End Of Life ◽

Healthcare Professionals ◽

Meta Analysis ◽

Educational Interventions ◽

End Of Life Communication

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Interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain: a systematic review

European Journal of Clinical Pharmacology ◽

10.1007/s00228-020-03026-4 ◽

2020 ◽

Author(s):

Aziza Alenezi ◽

Asma Yahyouche ◽

Vibhu Paudyal

Keyword(s):

Systematic Review ◽

Drug Testing ◽

Healthcare Professionals ◽

Data Extraction ◽

Healthcare Providers ◽

Educational Interventions ◽

Functional Improvement ◽

Behavioural Treatment ◽

Prescribed Medicines ◽

Medication Optimization

Abstract Purpose Sub-optimal opioid prescribing and use is viewed as a major contributor to the growing opioid crisis. This study aims to systematically review the nature, process and outcomes of interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain (CNMP) with a particular focus on minimizing misuse of opiates. Methods A systematic review of literature was undertaken. Search of literature using Medline, EMBASE and CINAHL databases from 2000 onwards was conducted. Screening and selection, data extraction and risk of bias assessments were undertaken by two independent reviewers. Narrative synthesis of the data was conducted. Results A total of 21 studies were included in the review, of which three were RCTs. Interventions included clinical (e.g. urine drug testing, opioid treatment contract, pill count), behavioural (e.g. electrical diaries about craving), cognitive behavioural treatment and/or educational interventions for patients and healthcare providers delivered as a single or as a multi-component intervention. Medication optimization outcomes included aspects of misuse, abuse, aberrant drug behaviour, adherence and non-adherence. Although all evaluations showed improvement in medication optimization outcomes, multi-component interventions were more likely to consider and to have shown improvement in clinical outcomes such as pain intensity, quality of life, psychological states and functional improvement compared to single-component interventions. Conclusions A well-structured CNMP management programme to promote medicines optimization should include multi-component interventions delivered by a multidisciplinary team of healthcare professionals and target both healthcare professionals and patients. There was heterogeneity in definitions applied and interventions evaluated. There is a need for the development of clear and consistent terminology and measurement criteria to facilitate better comparisons of research evidence.

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Training interventions to improve general hospital care for older people with cognitive impairment: systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.2019.29 ◽

2019 ◽

Vol 214 (4) ◽

pp. 201-212 ◽

Cited By ~ 5

Author(s):

Clare Abley ◽

Claire Dickinson ◽

Zoe Andrews ◽

Laura Prato ◽

Lyndsay Lindley ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Older People ◽

Hospital Care ◽

Health Management ◽

Educational Interventions ◽

Post Intervention ◽

Review Team ◽

Standard Quality ◽

Care For Older People

BackgroundIn response to increasing numbers of older people in general hospitals who have cognitive impairment such as dementia and delirium, many hospitals have developed education and training programmes to prepare staff for this area of clinical practice.AimsTo review the evidence on educational interventions on hospital care for older people with cognitive impairment.MethodA mixed methods systematic review and narrative synthesis was undertaken. The following electronic databases were searched: Medline, Embase, CINAHL, PsycINFO, EBM Reviews, ASSIA and Scopus, as well as Health Management Information Consortium (HMIC), ProQuest, PubMed and SCIE: Social Care Online. Initial searches were run in August 2014 (update search September 2016). Titles and abstracts of studies retrieved were screened independently. The full text of eligible studies were then independently assessed by two review team members. All included studies were assessed using a standard quality appraisal tool.ResultsEight studies relating to delirium, six on dementia and two on delirium and dementia were included, each testing the use of a different educational intervention. Overall, the quality of the studies was low. In relation to delirium, all studies reported a significant increase in participants' knowledge immediately post-intervention. Two of the dementia studies reported an increase in dementia knowledge and dementia confidence immediately post-intervention.ConclusionsThe variety of outcomes measured makes it difficult to summarise the findings. Although studies found increases in staff knowledge, there is insufficient evidence to conclude that educational interventions for staff lead to improved patient outcomes.Declaration of interestNone.

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Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care

Infection Control and Hospital Epidemiology ◽

10.1086/650451 ◽

2010 ◽

Vol 31 (3) ◽

pp. 283-294 ◽

Cited By ~ 495

Author(s):

Vicki Erasmus ◽

Thea J. Daha ◽

Hans Brug ◽

Jan Hendrik Richardus ◽

Myra D. Behrendt ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Hand Hygiene ◽

Intensive Care Units ◽

Hospital Care ◽

Empirical Studies ◽

Compliance Rate ◽

Activity Level ◽

Patient Contact ◽

Behavioral Determinants

Objectives.To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care.Design.A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates.Methods.Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed.Results.We included 96 empirical studies, the majority (n= 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%–40%) than in other settings (50%–60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n= 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results.Conclusions.Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.

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