RIVM National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Antimicrob Resist Infect Control. 2022 Oct 5;11(1):123. doi: 10.1186/s13756-022-01148-1.
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.
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.
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.
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.
传统的手部卫生（HH）干预措施无法识别观察到的医护人员（HCWs），因此仅反映人群层面的 HH 依从性。参与“通过干预和培训预防医院感染”（PROHIBIT）研究的 7 家欧洲医院的重症监护病房（ICUs）提供了个体 HH 依从性水平。我们对这些数据进行了分析，以了解个体变化的决定因素和动态，以及与整体干预效果的关系。
我们纳入了至少在干预前后提供了两次观察期的 HCWs。将改善、无变化和恶化的 HCWs 定义为依从性变化超过 20%的 HCWs。我们使用多变量线性回归和斯皮尔曼等级相关来估计个体对干预的反应的决定因素，并与整体变化相关联。群集图可视化了 ICU 特定的模式。
共有 280 名 HCWs 在 2677 次观察中贡献了 17748 次 HH 机会。总体而言，HH 依从性从 43.1%提高到了 58.7%。在各个 ICU 中，改善 HCWs 的比例从 33%到 95%不等。每个改善的 HCW 的 HH 平均提高幅度从 16%到 34%不等。ICU 范围内的改善与改善 HCWs 的比例（ρ=0.82 [95%CI 0.18-0.97]）和他们的中位数 HH 提高（ρ=0.79 [0.08-0.97]）均呈显著相关。多水平回归表明，个体改善与护士职业、较低的活动指数、较高的护士与患者比例以及较低的基线依从性显著相关。
改善 HCWs 的比例及其中位数个体改善在 ICU 之间存在显著差异，但与 ICU 的整体 HH 改善相关。在具有可比的总体平均值的情况下，一些医院之间的个体 HH 范围差异很大，这意味着存在不同的传播风险。更深入地了解改善动态可能有助于未来设计更有效的 HH 干预措施。
