Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control/Epidemiology and Surveillance Unit, Bilthoven, the Netherlands.
Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
J Am Med Dir Assoc. 2024 Apr;25(4):591-598. doi: 10.1016/j.jamda.2023.06.020. Epub 2023 Aug 4.
This study evaluated the effect of a tailored, multifaceted improvement strategy on hand hygiene compliance in long-term care facilities (LTCFs). We also performed a process evaluation to explore the mechanisms through which our strategy brought about change.
We conducted a stepped-wedge cluster-randomized controlled trial with a sequential rollout of the improvement strategy to all participating LTCFs. The strategy consisted of education, training, reminders, observation sessions (including feedback), and team meetings (including feedback).
The study included nursing professionals from 14 LTCFs (23 wards) in the Netherlands.
Hand hygiene compliance was observed during 5 measurement periods using WHO's "Five Moments for Hand Hygiene." Multilevel analyses and corresponding tests were completed on an intention-to-treat basis.
The absolute intervention effect of overall hand hygiene compliance (primary outcome measure) was 13% (95% CI 9.3-16.7, P < .001), adjusted for time and clustering. The adjusted absolute effect was 23% (95% CI 7-39, P < .002) before a clean and aseptic procedure, 18% (95% CI 10-26, P < .001) after touching a resident, 14% (95% CI 7-22, P < .003) before touching a resident, 10% (95% CI 5-15, P < .001) after contact with body fluid, and 1% (95% CI -11 to 13, P = .8) after touching a resident's surroundings. With the exception of leadership, participants at LTCFs with more exposure to the intervention components showed statistically significantly more improvement than those at facilities with lower exposure scores.
Our strategy was successful in improving hand hygiene compliance. LTCFs with more team members exposed to the different intervention components, demonstrated a greater effect from the intervention. To strengthen the impact of our intervention, we recommend that future improvement strategies provide more support to managers to ensure they are better equipped to take on their leadership roles and enable their teams to improve and maintain hand hygiene compliance.
本研究评估了针对长期护理机构（LTCF）的定制、多方面改进策略对手卫生依从性的影响。我们还进行了一项过程评估，以探讨我们的策略带来改变的机制。
我们进行了一项阶梯式楔形集群随机对照试验，逐步向所有参与的 LTCF 推出改进策略。该策略包括教育、培训、提醒、观察会议（包括反馈）和团队会议（包括反馈）。
该研究包括来自荷兰 14 个 LTCF（23 个病房）的护理专业人员。
使用世卫组织的“五个手卫生时刻”，在 5 个测量期间观察手卫生依从性。基于意向治疗进行多水平分析和相应的检验。
整体手卫生依从性的干预效果绝对值（主要结局指标）为 13%（95%置信区间 9.3-16.7，P<.001），调整了时间和聚类因素。在进行清洁和无菌操作前，调整后的绝对效果为 23%（95%置信区间 7-39，P<.002），接触居民后为 18%（95%置信区间 10-26，P<.001），接触居民前为 14%（95%置信区间 7-22，P<.003），接触体液后为 10%（95%置信区间 5-15，P<.001），接触居民周围环境后为 1%（95%置信区间 -11 至 13，P=.8）。除领导能力外，暴露于干预措施的团队成员较多的 LTCF 显示出统计学上更显著的改善，而暴露于干预措施的团队成员较少的 LTCF 则显示出更低的改善。
我们的策略成功地提高了手卫生依从性。暴露于不同干预措施的团队成员较多的 LTCF 显示出了更大的干预效果。为了增强我们的干预效果，我们建议未来的改进策略为管理人员提供更多支持，以确保他们能够更好地承担领导角色，并使他们的团队能够提高和维持手卫生依从性。
