Pires Daniela, Gayet-Ageron Angele, Guitart Chloe, Robert Yves-Alain, Fankhauser Carolina, Tartari Ermira, Peters Alexandra, Tymurkaynak Funda, Fourquier Simon, Soule Herve, Beuchat Rene, Bellissimo-Rodrigues Fernando, Martin Yves, Zingg Walter, Pittet Didier
Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety-Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
iQati, Sion, Switzerland.
JAMA Netw Open. 2021 Feb 1;4(2):e2035331. doi: 10.1001/jamanetworkopen.2020.35331.
Hand hygiene (HH) is essential to prevent hospital-acquired infections.
To determine whether providing real-time feedback on a simplified HH action improves compliance with the World Health Organization's "5 Moments" and the quality of the HH action.
DESIGN, SETTING, AND PARTICIPANTS: This open-label, cluster randomized, stepped-wedge clinical trial was conducted between June 1, 2017, and January 6, 2018 (with a follow-up in March 2018), in a geriatric hospital of the University of Geneva Hospitals, Switzerland. All 12 wards and 97 of 306 eligible health care workers (HCWs) volunteered to wear a novel electronic wearable device that delivered real-time feedback on duration of hand rubbing and application of a hand-sized customized volume of alcohol-based handrub (ABHR).
This study had 3 sequential periods: baseline (no device), transition (device monitoring without feedback), and intervention (device monitoring and feedback). The start of the transition period was randomly allocated based on a computer-generated block randomization.
The primary outcome was HH compliance, according to the direct observation method during intervention as compared with baseline. Secondary outcomes included the volume of ABHR and duration of hand rubbing measured by the device during intervention as compared with transition.
All wards and respective HCWs were evenly assigned to group 1 (26 participants), 2 (22 participants), 3 (25 participants), or 4 (24 participants). Twelve HCWs did not fully complete the intervention but were included in the analysis. During 759 observation sessions, 6878 HH opportunities were observed. HH compliance at intervention (62.9%; 95% CI, 61.1%-64.7%) was lower than at baseline (66.6%; 95% CI, 64.8%-68.4%). After adjusting for covariates, HH compliance was not different between periods (odds ratio, 1.03; 95% CI, 0.75-1.42; P = .85). Days since study onset (OR, 0.997; 95% CI, 0.994-0.998; P < .001), older age (OR, 0.97; 95% CI, 0.95-0.99; P = .015), and workload (OR, 0.29; 95% CI, 0.20-0.41; P < .001) were independently associated with reduced HH compliance. The median (interquartile range) volume of ABHR and duration of hand rubbing in transition and intervention increased from 1.12 (0.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds, respectively. There were no serious adverse events.
The use of this device did not change HH compliance, but increased the duration of hand rubbing and volume of ABHR used by HCWs.
isrctn.org Identifier: ISRCTN25430066.
手部卫生对于预防医院获得性感染至关重要。
确定提供关于简化手部卫生操作的实时反馈是否能提高对世界卫生组织“五个时刻”的依从性以及手部卫生操作的质量。
设计、地点和参与者：这项开放标签、整群随机、阶梯式楔形临床试验于2017年6月1日至2018年1月6日（2018年3月进行随访）在瑞士日内瓦大学医院的一家老年医院开展。306名符合条件的医护人员中的12个病房和97人自愿佩戴一种新型电子可穿戴设备，该设备可对手部揉搓持续时间以及涂抹定制量的手部大小的酒精基洗手液（ABHR）提供实时反馈。
本研究有3个连续阶段：基线期（无设备）、过渡期（设备监测但无反馈）和干预期（设备监测及反馈）。过渡期的开始根据计算机生成的区组随机化进行随机分配。
主要结局是干预期间与基线期相比，根据直接观察法得出的手部卫生依从性。次要结局包括干预期间与过渡期相比，设备测量的ABHR量和手部揉搓持续时间。
所有病房及各自的医护人员被均匀分配到第1组（26名参与者）、第2组（22名参与者）、第3组（25名参与者）或第4组（24名参与者）。12名医护人员未完全完成干预，但被纳入分析。在759次观察期间，共观察到6878次手部卫生机会。干预期的手部卫生依从性（62.9%；95%置信区间，61.1%-64.7%）低于基线期（66.6%；95%置信区间，64.8%-68.4%）。在对协变量进行调整后，各阶段的手部卫生依从性无差异（优势比，1.03；95%置信区间，0.75-1.42；P = 0.85）。自研究开始后的天数（优势比，0.997；95%置信区间，0.994-0.998；P < 0.001）、年龄较大（优势比，0.97；95%置信区间，0.95-0.99；P = 0.015）以及工作量（优势比，0.29；95%置信区间，0.20-0.41；P < 0.001）与手部卫生依从性降低独立相关。过渡期和干预期ABHR的中位数（四分位间距）量以及手部揉搓持续时间分别从1.12（0.76-1.68）mL增加到1.71（1.01-2.76）mL，从6.5（4.5-10.5）秒增加到8（4.5-15.5）秒。未发生严重不良事件。
使用该设备并未改变手部卫生依从性，但增加了医护人员手部揉搓的持续时间和ABHR的使用量。
isrctn.org标识符：ISRCTN25430066。
