Team-Directed Strategy Improves Healthcare Worker Hand Hygiene

Researchers from Radbound University at Nijmegen Medical Centre, in Nijmegen, Netherlands acknowledge that improving hand hygiene (HH) compliance is still a major challenge, and they report on a study in which they compared a literature based 'state of the art' strategy with a 'team directed' strategy, based on social influence and leadership, on their effectiveness on HH compliance.

The researchers undertook a cluster randomized trial with inpatient wards as the unit of randomization. The 'state-of-the-art' strategy (SAS) included education, reminders, feedback and targeting adequate products and facilities. The 'team-directed' strategy (TD) also contained activities based on social influence and leadership, gaining active commitment and initiative of ward management, modeling by informal leaders, and setting norms and targets within the team. Strategies were delivered during a period of six months. Measurements took place directly before and after strategy delivery and six months later. The effects were evaluated on an intention-to-treat basis by comparing the post-strategy hand hygiene compliance rates with the baseline rates. Multi-level analysis was applied to compensate for the clustered nature of the data by using mixed linear modeling techniques.

The SAS showed a short-term improvement of 19.6 percent and a long term improvement of 23.7 percent. The improvement for the TD was 33.7 percent (short term) and 33.1 percent (long term). The difference between TD and SAS showed an odds ratio of 1.641 (p<0.001) in favor of the 'team directed' strategy.

Huis, et al. conclude that both the 'state-of-the-art' strategy and the 'team-directed' strategy successfully improved hand hygiene compliance, but the team-directed' strategy showed even better results. The methodology of this team-directed strategy can also be used to improve team performance on other patient safety issues. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland June 29-July 2, 2011.

Reference: A Huis, L Schoonhoven, R Grol, R Donders, M Hulscher and T van Achterberg. Comparing short term and sustained effects of two strategies to improve nurses adherence with hand hygiene prescriptions: a cluster randomized trial. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):P119doi:10.1186/1753-6561-5-S6-P119. http://www.biomedcentral.com/1753-6561/5/S6/P119