Patient participation and optimised performance feedback to improve hand hygiene compliance amongst healthcare workers and reduce nosocomial infections
| ISRCTN | ISRCTN43599478 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN43599478 |
| Secondary identifying numbers | 3200B0122324/1 |
- Submission date
- 27/03/2012
- Registration date
- 30/04/2012
- Last edited
- 08/09/2016
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Infections and Infestations
Plain English summary of protocol
Background and study aims
Healthcare-associated infections (HAIs) represent the leading preventable adverse event amongst hospitalised patients. Hand hygiene is considered the single most important measure to prevent HAIs.
Previous studies have shown that campaigns to promote hand hygiene must contain multiple elements (multimodal), but the relative importance of each component remains unclear. In addition, to achieve further improvement, new strategies might be required given that sustained improvement has rarely been achieved. Another important issue is the extent to which hand hygiene can prevent HAIs. In this study, we aim to assess the effectiveness of two different strategies (enhanced performance feedback and patient participation) to produce a sustained improvement in healthcare worker hand hygiene. In addition, we aim to test the impact of increased hand hygiene compliance on HAIs and refine the understanding of factors associated with hand hygiene behaviour.
Who can participate?
This study will take place at the University of Geneva Hospitals. All healthcare workers working in and patients admitted to wards in which the study is active will participate in the study.
What does the study involve?
After an initial baseline period, the intervention phase will continue for two years. Wards will be randomly allocated to one of three groups: 1) standard multimodal hand hygiene promotion, 2) standard hand hygiene promotion with additional enhanced performance feedback, or 3) standard hand hygiene promotion with additional enhanced performance feedback and patient participation.
What are the possible benefits and risks of participating?
The major benefit is the possibility of improved hand hygiene and therefore a lower risk of hospital-associated infection.
Where is the study run from?
The study will be conducted at the University of Geneva Hospitals, Geneva, Switzerland.
When is the study starting and how long is it expected to run for?
The active intervention phase of the study will run for two years from July 2010.
Who is funding the study?
This study in funded by a grant from the Swiss National Science Foundation.
Who is the main contact?
Dr Hugo Sax, hugo.sax@hcuge.ch
Professor Didier Pittet, didier.pittet@hcuge.ch
Contact information
Scientific
Service Prévention et Contrôle de l'Infection
Hôpitaux Universitaires de Genève
Rue Gabrielle-Perret-Gentil 4
Genève
1211
Switzerland
Study information
| Study design | Single-centre cluster-randomized controlled trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Cluster randomised trial |
| Study setting(s) | Hospital |
| Study type | Prevention |
| Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
| Scientific title | Effectiveness of enhanced performance feedback and patient participation to improve hand hygiene amongst healthcare workers and reduce healthcare-associated infections: a cluster randomised controlled trial |
| Study objectives | A statistically significant increase in hand hygiene compliance will occur in each of the interventional study arms, and that the increase will be greater in the arm receiving both interventions. We also hypothesise that the increase in hand hygiene compliance will lead to a decreased incidence of healthcare-associated infections (HAIs) and in a reduced transmission of multiresistant bacteria. |
| Ethics approval(s) | Internal Medicine Ethics Committee (Comité départemental d'éthique de médecime interne et médecine départementale), 27/01/2010, ref: 09-299 |
| Health condition(s) or problem(s) studied | Healthcare-associated infections |
| Intervention | The intervention phase will continue for 24 months. The intervention phase is preceded by a 15-month baseline phase. The level of randomization is the hospital ward. Wards will be randomly allocated to one of three groups: 1. Standard multimodal hand hygiene promotion 2. Standard hand hygiene promotion with additional enhanced performance feedback 3. Standard hand hygiene promotion with additional enhanced performance feedback and patient participation Enhanced performance feedback: comprised of immediate and systematic components. Following each observation session, hand hygiene observers provide immediate verbal and written feedback to the healthcare workers observed during that session. Systematic feedback is provided by emails and posters distributed at the end of each quarter of the intervention phase. Patient participation: On admission, patients are informed about the indications for their own and for healthcare worker (HCW) hand hygiene, with particular emphasis on hand hygiene 'before patient contact'. They are provided with a 'welcome kit' consisting of a brochure and bottle of alcohol-based hand rub (ABHR). Finally, they are invited to ask HCWs that do not perform hand hygiene in front of them to do so, just as HCWs would remind them, the patient, to perform hand hygiene when indicated. |
| Intervention type | Behavioural |
| Primary outcome measure | Overall hand hygiene compliance amongst healthcare workers measured by direct observation according to the WHO 'My 5 moments for hand hygiene' methodology. |
| Secondary outcome measures | 1. Hand hygiene compliance before patient contact measured by direct observation according to the WHO My 5 Moments methodology 2. ABHR consumption 3. New methicillin-resistant Staphylococcus aureus (MRSA) colonization rate 4. New MRSA colonization incidence rate 5. MRSA clinical isolates 6. New colonization with extended-spectrum beta-lactamse (ESBL) producing bacteria 7. ESBL-producing clinical isolates 8. Clostridium difficile associated diarhoea (CDAD) 9. Primary bloodstream infection (BSI) incidence rate 10. Secondary blood stream infections (BSI) incidence rate 11. Prevalence of HAI |
| Overall study start date | 01/04/2009 |
| Completion date | 30/06/2012 |
Eligibility
| Participant type(s) | Mixed |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | 8000 hospital admissions during the intervention phase |
| Key inclusion criteria | 1. For primary outcome and first secondary outcome: all healthcare workers in study wards 2. For other secondary outcomes: all patients admitted to study wards |
| Key exclusion criteria | Does not meet inclusion criteria |
| Date of first enrolment | 01/04/2009 |
| Date of final enrolment | 30/06/2012 |
Locations
Countries of recruitment
- Switzerland
Study participating centre
1211
Switzerland
Sponsor information
Hospital/treatment centre
24 rue du Général-Dufour
Geneva
1211
Switzerland
| Website | http://www.unige.ch/medecine/index.html |
|---|---|
"ROR" |
https://ror.org/01m1pv723 |
Funders
Funder type
Government
Private sector organisation / Trusts, charities, foundations (both public and private)
- Alternative name(s)
- Schweizerischer Nationalfonds, Swiss National Science Foundation, Fonds National Suisse de la Recherche Scientifique, Fondo Nazionale Svizzero per la Ricerca Scientifica, Fonds National Suisse, Fondo Nazionale Svizzero, Schweizerische Nationalfonds, SNF, SNSF, FNS
- Location
- Switzerland
Results and Publications
| Intention to publish date | |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not provided at time of registration |
| Publication and dissemination plan | Not provided at time of registration |
| IPD sharing plan |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | results | 01/12/2016 | Yes | No |
Editorial Notes
08/09/2016: Publication reference added.
