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Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study


van der Kooi, Tjallie; Sax, Hugo; Grundmann, Hajo; Pittet, Didier; de Greeff, Sabine; van Dissel, Jaap; Clack, Lauren; Wu, Albert W; Davitt, Judith; Kostourou, Sofia; Maguinness, Alison; Michalik, Anna; Nedelcu, Viorica; Patyi, Márta; Perme Hajdinjak, Janja; Prosen, Milena; Tellez, David; Varga, Éva; Veini, Fani; Ziętkiewicz, Mirosław; Zingg, Walter (2022). Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study. Antimicrobial Resistance and Infection Control, 11(1):123.

Abstract

BACKGROUND

Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the "Prevention of Hospital Infections by Intervention and Training" (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect.

METHODS

We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman's rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns.

RESULTS

In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18-0.97], and their median HH increase (ρ = 0.79 [0.08-0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance.

CONCLUSIONS

Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs' overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.

Abstract

BACKGROUND

Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the "Prevention of Hospital Infections by Intervention and Training" (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect.

METHODS

We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman's rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns.

RESULTS

In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18-0.97], and their median HH increase (ρ = 0.79 [0.08-0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance.

CONCLUSIONS

Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs' overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.

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Additional indexing

Contributors:PROHIBIT consortium
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
04 Faculty of Medicine > Institute of Implementation Science in Health Care
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Public Health, Environmental and Occupational Health
Health Sciences > Microbiology (medical)
Health Sciences > Infectious Diseases
Health Sciences > Pharmacology (medical)
Language:English
Date:5 October 2022
Deposited On:27 Dec 2022 14:58
Last Modified:28 Jun 2024 01:36
Publisher:BioMed Central
ISSN:2047-2994
Additional Information:CORRECTION of this article: van der Kooi, T., Sax, H., Grundmann, H. et al. Correction: Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study. Antimicrob Resist Infect Control 12, 13 (2023). https://doi.org/10.1186/s13756-023-01217-z // The original article [1] omitted an affiliation for Hugo Sax which has since been reinstated. The affiliation for Walter Zingg has also had a minor amendment.
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s13756-022-01148-1
Related URLs:https://doi.org/10.1186/s13756-023-01217-z (Publisher)
PubMed ID:36199149
  • Content: Published Version
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)
  • Content: Published Version
  • Language: English
  • Description: Correction of this article
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)