Research for infection protection
  • germs
  • Adenovirus
  • Aspergillus niger
  • Bovine virus diarrhea
  • Clostridium difficile
  • Candida albicans
  • Candida albicans
  • Coronavirus
  • Corynebacterium
  • Escherichia coli
  • Helicobacter pylori

Author: Diefenbacher et al. (2019) Source: Diefenbacher et al. (2019) A quasi-randomized controlled before-after study using performance feedback and goal setting as elements of hand hygiene promotion. J Hosp Infect 2019. pii: S0195-6701(19)30059-3. Epub ahead of print.

STUDY

Diefenbacher et al. (2019)

Improving hand hygiene through the novel approach of combining goal setting and performance feedback at the group level

Background: Hand hygiene (HH) is one of the key measures in the prevention of healthcare-associated infections. Various intervention strategies can improve HH compliance (HHC), but HHC rates are still low. New strategies that extend and complement existing programmes are needed. Behavioural approaches such as goal setting and performance feedback may help develop such strategies. This study aimed to test the potential of goal setting and performance feedback to improve HH at the group level.


Method: The prospective, controlled, before-after intervention study was conducted at a German tertiary hospital between April and August 2017. It was divided into four 4-week phases: habituation (T0), baseline (T1), intervention (T2), and post-intervention (T3). Existing wall-mounted dispensers were replaced by electronic count dispensers and supplemented by further of those to achieve a ratio of at least one per two beds. Dispenser usage data were transferred via WiFi and continuously collected as HH events (HHEs; 1 HHE=all dispenser activations within 2 sec). Four non-intensive care units of the hospital were assigned to one of four conditions: combined (feedback + goal setting), feedback only, goal setting only, or none (control), each of which was initialised on day 1 of T2. For goal setting, after receiving introductory information, the team defined a collective target HHC rate that was written on a poster and displayed at the notice board. Performance feedback was continuously given by screens on the wards, displaying the mean HHC rate of the last 7 days which was calculated from electronically counted HHEs. Trained observers also documented the alignment between HHEs and HHC by applying the recommendations of the World Health Organization (WHO; Five Moments).


Results: Overall, 1,894 HHEs were electronically registered: 422 in T0, 427 in T1, 576 in T2, and 469 in T3. For the combined condition (feedback + goal setting), the mean number of daily HHEs per patient room increased significantly from T1 (baseline; mean 7.9) to T2 (intervention; mean 17.0) and was still significantly elevated in T3 (post-intervention; mean 12.9). The two conditions with single interventions did not lead to statistically significant differences from baseline.

As a secondary outcome, these results were compared to HHEs per patient day for all conditions. For the combined condition, HHEs per patient day nearly doubled from T1 (baseline; mean 4.8) to T2 (intervention; mean 9.2) and remained elevated in T3 (post-intervention; mean 6.5). In addition, the observation data revealed that count dispenser usage frequency and HHC strongly correlated across all wards and study phases.


Conclusions: This study shows a strong intervention effect on HH frequency by combining performance feedback and goal setting at the group level, suggesting this a useful approach to improve HH. HH programmes can benefit by including not only feedback, as recommended by the WHO, but also goal setting.


Source:
Diefenbacher et al. (2019) A quasi-randomized controlled before-after study using performance feedback and goal setting as elements of hand hygiene promotion. J Hosp Infect 2019. pii: S0195-6701(19)30059-3. Epub ahead of print.


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