Springer Nature

Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study

Posted on 2022-10-06 - 07:37
Abstract Background 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. Methods 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. Results 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. Conclusions 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.


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Antimicrobial Resistance & Infection Control


Tjallie van der Kooi
Hugo Sax
Hajo Grundmann
Didier Pittet
Sabine de Greeff
Jaap van Dissel
Lauren Clack
Albert W. Wu
Judith Davitt
Sofia Kostourou
Alison Maguinness
Anna Michalik
Viorica Nedelcu
Márta Patyi
Janja Perme Hajdinjak
Milena Prosen
David Tellez
Éva Varga
Fani Veini
Mirosław Ziętkiewicz
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