Efficacy of Interventions Based on WHO Multimodal Hand Hygiene Improvement Strategy in a Tertiary Care Hospital in Eastern India: A Quasi-Experimental Study.

Ratnadeep Biswas, Ravi Kirti, Vishnu Shankar Ojha, Yash Jaiswal, Gurleen Kaur
Author Information
  1. Ratnadeep Biswas: Department of General Medicine, All India Institute of Medical Sciences, Patna, India.

Abstract

The study aimed to evaluate the efficacy of the World Health Organization (WHO) multimodal hand hygiene improvement (WHO-5) strategy in enhancing hand hygiene compliance among health care workers at a tertiary care hospital. The interrupted time series study included preintervention, intervention, and postintervention phases, with 2 points of observation each during the pre- and postintervention phases. The baseline hand hygiene compliance was 16%, which improved to 43.9% after the intervention. Health care workers were 4 times more likely to adhere to proper hand hygiene postintervention (odds ratio [OR], 4.117). Independent predictors of hand hygiene compliance included the week of observation (week 3: adjusted odds ratio [AOR], 0.872; week 5: AOR, 3.427; and week 7: AOR, 4.713), health care worker type (consultants: AOR, 0.964; residents: AOR, 2.187; and interns: AOR, 6.684), daytime (AOR, 1.232), and "after" type of hand hygiene opportunity (AOR, 1.577). No significant differences were found in knowledge, attitude, and practices pre- and postintervention, and the interventions' effect was sustained and increased over time, supporting implementation in hospitals across India.

References

Health care-associated infections - FACT SHEET. Accessed February 14, 2022. https://www.convatec.com/media/1286/gpsc_ccisc_fact_sheet_en.pdf .
Your 5 Moments for Hand Hygiene. Accessed February 14, 2022. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-and-control/your-5-moments-for-hand-hygiene-poster.pdf?sfvrsn=83e2fb0e_16 .
World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. 2nd ed. World Health Organization; 2018. Accessed September 28, 2022. https://apps.who.int/iris/handle/10665/277399 .
World Health Organization. Classification and Minimum Standards for Emergency Medical Teams. World Health Organization; 2021. Accessed September 28, 2022. https://apps.who.int/iris/handle/10665/341857 .
A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Accessed September 29, 2022. https://www.who.int/publications-detail-redirect/a-guide-to-the-implementation-of-the-who-multimodal-hand-hygiene-improvement-strategy .
King D, Vlaev I, Everett-Thomas R, et al. “Priming” hand hygiene compliance in clinical environments. Health Psychol. 2016;35:96–101.
Ojanperä H, Kanste OI, Syrjala H. Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland. Bull World Health Organ. 2020;98:475–483.
Hammerschmidt J, Manser T. Nurses’ knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Serv Res. 2019;19:547.
Kingston L, O’Connell NH, Dunne CP. Hand hygiene-related clinical trials reported since 2010: a systematic review. J Hosp Infect. 2016;92:309–320.
Clancy C, Delungahawatta T, Dunne CP. Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect. 2021;111:6–26.
Gould DJ, Moralejo D, Drey N, et al. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev. 2017;9:CD005186.
Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ. 2015;351:h3728.
Huis A, Schoonhoven L, Grol R, et al. Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. Int J Nurs Stud. 2013;50:464–474.
Huang J, Jiang D, Wang X, et al. Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in China. J Contin Educ Nurs. 2002;33:217–224.
Laskar AM, R D, Bhat P, et al. A multimodal intervention to improve hand hygiene compliance in a tertiary care center. Am J Infect Control. 2018;46:775–780.
Gopalakrishnan S, Chaurasia S, Sankar MJ, et al. Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India. J Perinatol. 2021;41:2834–2839.
Hand Hygiene Observation Tool. Accessed February 14, 2022. https://www.mnhospitals.org/Portals/0/Documents/ptsafety/ControllingCDI/5b_Controlling%20CDI%20Park%20Nicollet%20Methodist%20Hospital%20Hand%20Hygiene%20Auditing%20Tool.pdf .
Observation Form. Accessed February 14, 2022. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/hand-hygiene/monitoring/surveyform/observation-form.doc?sfvrsn=39b780c9_6 .
Hand Hygiene Knowledge Questionnaire for Health-Care Workers. Accessed February 14, 2022. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/hand-hygiene/monitoring/surveyform/hand-hygiene-knowledge-questionnaire.doc?sfvrsn=dbb4da65_2 .
Perception Survey for Health-Care Workers. Accessed February 14, 2022. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/hand-hygiene/monitoring/surveyform/perception-survey-for-health-care-workers.doc?sfvrsn=8fa7cb79_2 .
Hand Hygiene Guidance | Hand Hygiene | CDC. Published January 30, 2020. Accessed September 28, 2022. https://www.cdc.gov/handhygiene/providers/guideline.html .
Arthi E, Abarna V, Bagyalakshmi R, et al. Assessment of knowledge, attitude and practice of hand hygiene among nursing and medical students in a tertiary care hospital in Puducherry, India. Int J Contemp Med Res. 2016;3:1203–1206.
A Guide to the Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. Accessed February 14, 2022. https://apps.who.int/iris/rest/bitstreams/66218/retrieve .
WHO: SAVE LIVES - Clean Your Hands - No Action Today; No Cure Tomorrow . 2014. Accessed September 28, 2022. https://www.youtube.com/watch?v=kOKeFv5VvY4 .
The jamovi project (2022). Accessed September 15, 2022. https://www.jamovi.org .
Appendix 3: Analysis of interrupted time series data [posted as supplied by author]. Accessed February 14, 2022. https://www.bmj.com/content/bmj/suppl/2015/07/28/bmj.h3728.DC1/luan024450.ww3_default.pdf .
Ramsay CR, Matowe L, Grilli R, et al. Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care. 2003;19:613–623.
Thomas AM, Kaur S, Biswal M, et al. Effectiveness of hand hygiene promotional program based on the WHO multimodal hand hygiene improvement strategy, in terms of compliance and decontamination efficacy in an Indian tertiary level neonatal surgical intensive care unit. Indian J Med Microbiol. 2019;37:496–501.
Mathai AS, George SE, Abraham J. Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit. Indian J Crit Care Med. 2011;15:6–15.
Chang NCN, Reisinger HS, Schweizer ML, et al. Hand hygiene compliance at critical points of care. Clin Infect Dis. 2021;72:814–820.

MeSH Term

Humans
Hand Hygiene
Cross Infection
Tertiary Care Centers
Guideline Adherence
Health Personnel
World Health Organization
India
Hand Disinfection
Infection Control

Word Cloud

Similar Articles

Cited By