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Individual hand-hygiene feedback doubles compliance

Despite calls for patient safety, hand-hygiene compliance rates still remain disappointingly low with levels at 25 percent to 40 percent, University College London researchers said in a statement yesterday.

Called the Feedback Intervention Trial, the project is one of the largest studies of its kind in the world, involving 16 hospitals with a total of 60 wards, according to researchers. They found that both feedback and personalized action planning improved hand-hygiene compliance by up to 18 percent in intensive therapy units and 13 percent in elderly acute care wards. Soap use also increased by 30 percent.

The program includes four weeks. In the first week, a "ward coordinator," such as an infection control nurse, observes another nurse or healthcare assistant for 20 minutes and then gives immediate feedback and tips on how to improve. For instance, if the nurse doesn't use rubbing alcohol because she only touches the equipment and not the patient, the ward coordinator instructs her on the action plan to use alcohol.

The study notes that if the nurse is 100 percent compliant, she receives a certificate and praise. If the nurse fails two or more times, she is observed again the next month. The goal is that each staff member is observed at least once every year.

In the second week, healthcare professionals other than nurses, such as physicians, are observed, with the same process carried out.

In the third week, the ward is observed, and in the fourth week, the ward meeting assesses group compliance.
Although study authors noted the project may not work for other hospitals or other countries, they did say that other organizations could apply the individual feedback and action planning at their institutions.

"Hospitals keen to improve their hand-hygiene compliance could consider employing this intervention, with the same cycle and behavioral principles of feedback, to supplement their current audit and appraisal systems," they wrote.