Interventions to improve hand hygiene compliance in patient care

 

Abstract

Background

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure.

Objectives

To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection.

Search methods

We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009.

Selection criteria

Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting.

Data collection and analysis

Two reviewers independently extracted data and assessed data quality.

Main results

Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond 12 months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data.

Authors' conclusions

The quality of intervention studies intended to increase hand hygiene compliance remains disappointing. Although multifaceted campaigns with social marketing or staff involvement appear to have an effect, there is insufficient evidence to draw a firm conclusion. There remains an urgent need to undertake methodologically robust research to explore the effectiveness of soundly designed and implemented interventions to increase hand hygiene compliance.

 

Plain language summary

Methods to improve healthcare worker hand hygiene to decrease infection in hospitals

Patients in hospital, nursing homes and long-term care facilities are at high risk of developing infections that they did not have before admission. Most healthcare-associated infections are spread by direct contact, especially via the hands of healthcare workers. Traditionally, hand hygiene, such as washing hands before and after touching patients, has been considered the single most important way of reducing infections. Increasingly, the use of alcohol-based hand rub is used alongside or in replacement of traditional washing with soap and water. However, compliance with hand hygiene is poor.

This updated review sought to establish whether there are effective strategies to improve hand hygiene compliance, whether such strategies are effective over short or longer term and whether increased compliance reduces healthcare-associated infections.

There were four studies, two from the original review in 2007 and two from the update, which assessed the success of campaigns to improve hand hygiene compliance. Follow-up continued for longer than 12 months in two of the studies, but none of the studies was of high quality. Success in improving hand hygiene was inconsistent among the four studies.

There is still not enough evidence to be certain what strategies improve hand hygiene compliance. Introducing alcohol-based hand rub accompanied by education/training is not enough, while using multiple strategies, including involvement of staff in planning activities or applying social marketing strategies, may be helpful. More research is needed.

 

摘要

背景

改善病人照護中之手部衛生順從性的介入措施

與健康照護相關的感染是罹病率和死亡率的主要的原因。手部衛生被認為是有效的預防措施。

目標

評估改善遵從手部衛生短期和長期的成功策略，並確定手部衛生遵從性的持續增加，可以降低與健康照護相關的感染比率。

搜尋策略

我們進行電子資源的搜尋：登錄於Cochrane中心的控制性研究；登錄於Cochrane有效實務和專業團體照護機構的試驗；MEDLINE；PubMed；EMBASE；CINAHL； 及BNI。在2006年7月搜尋所有的資料庫；MEDLINE從1980年的資料開始搜尋、搜尋CINAHL開始的所有資料、其他的資料庫搜尋從1990年到2006年7月。

選擇標準

Cochrane有效實務和團體照護機構使用明確的納入及品質的標準於分析會議，摘取隨隨機對照試驗、對照性臨床試驗、前後對照的研究、及打斷時間序列之研究。報告遵從手部衛生的代表指標的研究被考慮。若資料內容是包含提供有關手部衛生的促進遵從性和普及性的預防，將分別呈現。

資料收集與分析

兩位評論者個別選取資料及評估研究品質。

主要結論

四篇研究符合評論的標準：兩篇來自原始的評論及兩篇來自更新的。兩篇研究 評?簡單教育計畫、一篇使用隨機臨床試驗設計及其他為前後對照設計。兩者經直接觀察測量手部衛生順從性。其他兩篇研究是兩個打段時間序列研究。一篇研究呈現三種分開的介入措施：簡單替代產品及兩種多方面的活動，一個納入醫師做選擇手部衛生產品的決策及手部衛生計畫的內容。其他的研究也呈現兩種分開的多方面的活動，一個包括應用社會行銷理論。這兩篇研究資料追蹤收集12個月，及記錄監測手部衛生順從性。 一篇研究中紀錄微生物學資料。一篇由直接觀察測量的研究其手部衛生順從性增加，但是另一篇的結果未確實。兩篇研究報告產品使用增加，但對同一計畫的結果報告不一致。一篇研究報告微生物資料中MRSA發生率下降。

作者結論

預期增加手部衛生順從性的介入研究的品質令人失望。雖然多方面的活動及社會行銷或工作人員參與顯示有效果，仍無法充分的證實而沒有肯定的結論。留下了急迫需要進行方法學穩健研究，以探討嚴格設計及執行增加手部衛生順從性措施的有效性。

翻譯人

本摘要由高雄榮民總醫院林麗英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在醫院改善健康照護工作人員手部衛生以降低感染的方法：病人在醫院、護理之家及長期照護機構，是他們在入院前沒有感染而會發展感染的高危險地方。多數與健康照護相關的感染被散播是經由直接接觸，特別是經由健康照護工作人員的手。傳統，手部衛生，像是接觸病人前後洗手，被認為是單一降低感染的最重要方法。逐漸的，使用酒精為基礎的手部摩擦並列或替代傳統的以肥皂和水的洗手。無論如何，手部衛生的順從性是缺乏的。這篇更新的評論尋找是否有有效的策略去改善手部衛生順從性。是否短期或長期的策略是有效的及是否增加順從性可降低健康照護相關的感染。有四篇研究，兩篇來自2007年的原始評論及兩篇來自於更新版，其評估改善手部衛生順從性活動的成功情形。在兩篇研究中，追蹤比12週較長期的持續性，但是沒有一篇是高品質的。在四篇研究中成功的改善手部衛生的結果是不一致的。仍然沒有足夠的證據可確定什麼樣的策略可改善手部衛生順從性。提倡以酒精為基礎的手部摩擦，伴隨教育/訓練是不足夠的，當使用多種策略，包括人員參與計畫活動或應用社會行銷策略，可能是有幫助的。更多的研究是需要的。