1Department of Medical Microbiology and Infectious Diseases,Erasmus MC,University Medical Center Rotterdam,Rotterdam,The Netherlands.
2Department of Public Health,Erasmus MC,University Medical Center Rotterdam,Rotterdam,The Netherlands.
Infect Control Hosp Epidemiol. 2019 Feb;40(2):187-193. doi: 10.1017/ice.2018.261.
To investigate the effects of friendly competition on hand hygiene compliance as part of a multimodal intervention program.
Prospective observational study in which the primary outcome was hand hygiene compliance. Differences were analyzed using the Pearson χ2 test. Odds ratios (ORs) with 95% confidence interval were calculated using multilevel logistic regression.
Observations were performed in 9 public hospitals and 1 rehabilitation center in Rotterdam, Netherlands.ParticipantsFrom 2014 to 2016, at 5 time points (at 6-month intervals) in 120 hospital wards, 20,286 hand hygiene opportunities were observed among physicians, nurses, and other healthcare workers (HCWs).InterventionThe multimodal, friendly competition intervention consisted of mandatory interventions: monitoring and feedback of hand hygiene compliance and optional interventions (ie, e-learning, kick-off workshop, observer training, and team training). Hand hygiene opportunities, as formulated by the World Health Organization (WHO), were unobtrusively observed at 5 time points by trained observers. Compliance data were presented to the healthcare organizations as a ranking.
The overall mean hand hygiene compliance at time point 1 was 42.9% (95% confidence interval [CI], 41.4-44.4), which increased to 51.4% (95% CI, 49.8-53.0) at time point 5 (P<.001). Nurses showed a significant improvement between time points 1 and 5 (P<.001), whereas the compliance of physicians and other HCWs remained unchanged. In the multilevel logistic regressions, time points, type of ward, and type of HCW showed a significant association with compliance.
Between the start and the end of the multimodal intervention program in a friendly competition setting, overall hand hygiene compliance increased significantly.
研究友好竞争对手卫生依从性的影响，作为多模式干预计划的一部分。
前瞻性观察研究，主要结局是手卫生依从性。使用 Pearson χ2 检验分析差异。使用多水平逻辑回归计算优势比（OR）和 95%置信区间。
荷兰鹿特丹的 9 家公立医院和 1 家康复中心。
2014 年至 2016 年，在 120 个病房的 5 个时间点（每 6 个月 1 次），观察了 20286 次医生、护士和其他医护人员（HCWs）的手卫生机会。
友好竞争的多模式干预包括强制性干预：手卫生依从性的监测和反馈，以及可选干预（即电子学习、启动研讨会、观察员培训和团队培训）。按照世界卫生组织（WHO）的规定，由经过培训的观察员在 5 个时间点进行非干扰性观察。依从性数据以排名的形式呈现给医疗保健组织。
第 1 时间点的总体手卫生依从率为 42.9%（95%置信区间[CI]，41.4-44.4），第 5 时间点提高至 51.4%（95% CI，49.8-53.0）（P <.001）。护士在第 1 时间点和第 5 时间点之间有显著改善（P <.001），而医生和其他 HCWs 的依从率保持不变。在多水平逻辑回归中，时间点、病房类型和 HCW 类型与依从性显著相关。
在友好竞争环境下的多模式干预计划开始和结束之间，整体手卫生依从性显著提高。
