Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T06:27:33.727Z Has data issue: false hasContentIssue false
  • English
  • Français

Hand hygiene promotion delivered by change agents—Two attitudes, similar outcome

Published online by Cambridge University Press:  13 January 2020

Yew Fong Lee ,
Mary-Louise McLaws ,
Loke Meng Ong ,
Suraya Amir Husin ,
Hock Hin Chua ,
See Yin Wong ,
Didier Pittet  and
Walter Zingg
Yew Fong Lee
Affiliation:
Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland Ministry of Health, Kuala Lumpur, Malaysia
Mary-Louise McLaws
Affiliation:
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
Loke Meng Ong
Affiliation:
Clinical Research Centre & Department of Medicine, Hospital Pulau Pinang, Georgetown, Malaysia
Suraya Amir Husin
Affiliation:
Ministry of Health, Kuala Lumpur, Malaysia
Hock Hin Chua
Affiliation:
Sarawak General Hospital, Kuching, Sarawak, Malaysia
See Yin Wong
Affiliation:
Sarawak General Hospital, Kuching, Sarawak, Malaysia
Didier Pittet
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Walter Zingg*
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Author for correspondence: Walter Zingg, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care.

Design:

Randomized-controlled study.

Setting:

Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia.

Methods:

We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours.

Results:

Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%–53%) and 50% (95% CI, 44%–55%) in the preintervention period to 66% (63%–69%) and 65% (60%–69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals.

Conclusion:

Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 3 , March 2020 , pp. 273 - 279
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

WHO World Alliance for Patient Safety. World Health Organization website. https://www.who.int/patientsafety/worldalliance/en/. Published 2004. Accessed August 27, 2019.Google Scholar
Pittet, D, Donaldson, L.Clean Care is Safer Care: The first global challenge of the WHO World Alliance for Patient Safety. Am J Infect Control 2005;33:476–479.CrossRefGoogle ScholarPubMed
WHO Evidence for Hand Hygiene Guidelines. World Health Organization website. https://www.who.int/gpsc/tools/faqs/evidence_hand_hygiene/en/. Published 2009. Accessed August 27, 2019.Google Scholar
Larson, EL, Early, E, Cloonan, P, Sugrue, S, Parides, M.An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:14–22.CrossRefGoogle ScholarPubMed
Whitby, M, McLaws, M-L, Slater, K, Tong, E, Johnson, B.Three successful interventions in health care workers that improve compliance with hand hygiene: Is sustained replication possible? Am J Infect Control 2008;36:349–355.CrossRefGoogle ScholarPubMed
Pittet, D, Hugonnet, S, Harbarth, S, et al., Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
WHO guide to implementation of the WHO multimodal hand hygiene improvement strategy, 2009. https://apps.who.int/iris/handle/10665/70030. Accessed August 27, 2019.Google Scholar
Schweizer, ML, Reisinger, HS, Ohl, M, et al.Searching for an optimal hand hygiene bundle: a meta-analysis. Clin Infect Dis 2014;58:248–259.CrossRefGoogle ScholarPubMed
Luangasanatip, N, Hongsuwan, M, Limmathurotsakul, D, et al.Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015;351:h3728.CrossRefGoogle ScholarPubMed
Zingg, W, Holmes, A, Dettenkofer, M, et al.Hospital organisation, management, and structure for prevention of healthcare-associated infection: a systematic review and expert consensus. Lancet Infect Dis 2015;15:212–224.CrossRefGoogle ScholarPubMed
Calhoun, Craig Jackson. Robert K. Merton: Sociology of Science and Sociology as Science. Brooklyn, NY: Columbia University Press; 2011.Google Scholar
Valente, TW, Pumpuang, P.Identifying Opinion Leaders to Promote Behavior Change. Heal Educ Behav 2007;34:881–896.CrossRefGoogle ScholarPubMed
Damschroder, LJ, Banaszak-Holl, J, Kowalski, CP, Forman, J, Saint, S, Krein, SL.The role of the champion in infection prevention: results from a multisite qualitative study. Qual Saf Health Care 2009;18:434–440.CrossRefGoogle ScholarPubMed
Greenhalgh, T, Robert, G, Macfarlane, F, Bate, P, Kyriakidou, O.Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82:581–629.CrossRefGoogle ScholarPubMed
Kwok, YLA, Harris, P, McLaws, M-L.Social cohesion: the missing factor required for a successful hand hygiene program. Am J Infect Control 2017;45:222–227.CrossRefGoogle ScholarPubMed
Rogers, EM.Diffusion of Innovations. 5th ed. New York: Free Press; 2003.Google Scholar
Malaysia. The World Bank website. http://www.worldbank.org/en/country/malaysia. Published 2019. Accessed August 27, 2019.Google Scholar
Sarawak Government Department of Statistics Malaysia Official Portal. Malaysian Government website. https://www.dosm.gov.my/v1/index.php?r=column/cone&menu_id=clJnWTlTbWFHdmUwbmtSTE1EQStFZz09. Published 2019. Accessed August 27, 2019.Google Scholar
WHO Guidelines on Hand Hygiene in Health Care. World Health Organization website. https://www.who.int/gpsc/5may/tools/9789241597906/en/. Published 2009. Accessed August 27, 2019.Google Scholar
Lloyd, RC.Quality Health Care: A Guide to Developing and Using Indicators. 2nd ed. Burlington, MA: Jones and Bartlett; 2004.Google Scholar
World Health Organization. WHO Hand Hygiene Self-Assessment Framework. World Health Organization website. http://www.who.int/gpsc/5may/hhsa_framework/en/. Published 2011. Accessed August 27, 2019.Google Scholar
Stewardson, AJ, Allegranzi, B, Perneger, TV, Attar, H, Pittet, D.Testing the WHO Hand Hygiene Self-Assessment Framework for usability and reliability. J Hosp Infect 2013;83:30–35.CrossRefGoogle ScholarPubMed
Allegranzi, B, Conway, L, Larson, E, Pittet, D.Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities. Am J Infect Control 2014;42:224–230.CrossRefGoogle ScholarPubMed
Kilpatrick, C, Tartari, E, Gayet-Ageron, A, et al.Global hand hygiene improvement progress: two surveys using the WHO Hand Hygiene Self-Assessment Framework. J Hosp Infect 2018;100:202–206.CrossRefGoogle ScholarPubMed
Lee, YF, Suraya, AH, Zingg, W, et al.Hand Hygiene Self-Assessment Framework (HHSAF) survey of 23 hospitals in Sarawak, Malaysia. Antimicrob Resist Infect Control 2017;6:52.Google Scholar
Sax, H, Allegranzi, B, Uçkay, I, Larson, E, Boyce, J, Pittet, D.‘My Five Moments for Hand Hygiene’: a user-centered design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.CrossRefGoogle Scholar
My Five Moments for Hand Hygiene, 2017. https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/. Accessed August 27, 2019.Google Scholar
Hand hygiene monitoring and feedback. World Health Organization website. https://www.who.int/gpsc/5may/monitoring_feedback/en/. Published 2013. Accessed August 27, 2019.Google Scholar
List randomizer. Random.org website. https://www.random.org/lists/. Accessed July 24, 2019.Google Scholar
Azim, S, Juergens, C, McLaws, M-L.An average hand hygiene day for nurses and physicians: the burden is not equal. Am J Infect Control 2016;44:777–781.CrossRefGoogle Scholar
Tools for evaluation and feedback. World Health Organization website. https://www.who.int/gpsc/5may/tools/evaluation_feedback/en/. Published 2011. Accessed August 27, 2019.Google Scholar
Lee, YF, McLaws, ML, Ong, LM, Amir Husin, S, Chua, HH, Wong, SY, Pittet, D, Zingg, W. Hand hygiene - social network analysis of peer-identified and management-selected change agents. Antimicrob Resist Infect Control 2019; 8: 195.CrossRefGoogle ScholarPubMed
Landis, JR, Koch, GG.The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977;33:159.CrossRefGoogle ScholarPubMed
Provost, LP, Murray, SK.The Health Care Data Guide: Learning From Data for Improvement. 1st ed. San Francisco: Jossey-Bass; 2011.Google Scholar
Shewhart, WA, Walter, A.Economic Control of Quality of Manufactured Product. Milwaukee, WI: Quality Press; 1980.Google Scholar
Wheeler, DJ, Chambers, DS.Understanding Statistical Process Control. 3rd ed. Knoxville, TN: SPC Press; 2010.Google Scholar
Role model. Cambridge English Dictionary website. https://dictionary.cambridge.org/dictionary/english/role-model. Published 2019.Google Scholar
Festinger, L.A Theory of Cognitive Dissonance. Stanford, CA: Stanford University Press; 1957.Google Scholar
McCambridge, J, Witton, J, Elbourne, DR.Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol 2014;67:267–277.CrossRefGoogle ScholarPubMed
Chen, LF, Vander Weg, MW, Hofmann, DA, Reisinger, HS.The Hawthorne effect in infection prevention and epidemiology. Infect Control Hosp Epidemiol 2015;36:1444–1450.CrossRefGoogle ScholarPubMed