Scientific article
Open access

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

Published inAntimicrobial resistance and infection control, vol. 11, no. 1, 123
  • The original article omitted an affiliation for Hugo Sax which has since been reinstated. The affiliation for Walter Zingg has also had a minor amendment.
  • DOI : 10.1186/s13756-023-01217-z
  • PMID : 36804991
Publication date2022-10-05
First online date2022-10-05

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.

  • Activity index
  • Hand hygiene
  • Individual
  • Intensive care
  • Intervention
  • Multicentre
  • Cross Infection / prevention & control
  • Guideline Adherence
  • Hand Hygiene / methods
  • Health Personnel
  • Humans
  • Intensive Care Units
  • European Commission 7th Framework Programme -
Citation (ISO format)
VAN DER KOOI, Tjallie et al. Hand hygiene improvement of individual healthcare workers: results of the multicentre prohibit study. In: Antimicrobial resistance and infection control, 2022, vol. 11, n° 1, p. 123. doi: 10.1186/s13756-022-01148-1
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ISSN of the journal2047-2994

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