Hand Hygiene Compliance:

The Role of Interactive vs. Passive Education in Improving Hand Hygiene

A Randomized Control Study

Christine Klucznik

Telana FairchildErica Magaziner

Molly RivestUMass - Worcester, Graduate School of Nursing

Healthcare associated infections (HAI’s) are a serious public health concern that contributes to increased mortality, morbidity and health care cost. Effective hand hygiene has been linked to the prevention of HAI’s and is an evidence-based intervention that can reduce infection rates. Compliance with hand hygiene in health care settings continues to be a significant issue. Behavioral researchers believe that a change in practice will not occur until an individual practitioner experiences the effects of inadequate hand hygiene. These authors investigated whether an interactive hand hygiene educational program was more effective in increasing compliance over a passive educational module.

Context

ObjectiveTo investigate the efficacy of interactive hand hygiene training as compared to passive on-line learning module training in improving hand hygiene compliance

Is a randomized controlled trial conducted on a 28 bed pediatric unit in a 500 bed tertiary academic medical center

Comparing interactive hand hygiene education versus the current passive hand hygiene education module for compliance with hand hygiene by nurses

Methods – Design

Methods – Design (cont.)Subjects are randomly selected using a

computer generated randomizationTraining period is 30 daysData collection period is 6 monthsFollowed guidelines published in the

Agency for Healthcare Research and Quality (AHRQ)

Approved by hospital Medical Executive Committee and the Infection Control Committee

Method – Design (cont.)Settingo Chicago, ILo Urban Hospital, 500 bed tertiary

academic medical centero 28 bed Pediatric Unit with 50 staff

nurseso Ratio of nurse to patient, 1:3

Method - SubjectsEntry Criteriao Must be a staff nurse on pediatric floor

with direct patient contacto Must have worked on the pediatric floor

for >1 yearExclusionary Criteriao Cannot be a float or travel nurseo Cannot be a charge nurse

IRB granted waiver

Staff nursesLicense heldYears as a nurseHours worked per weekShift workedGender

Study Sample: Baseline Characteristics

Method - SubjectsIntervention – interactive learningo Participants receive a demonstration

training using Glo-germ™ (hand washing UV light kit)

Method - SubjectsControl – passive

learningo Participants receive

the institutional standard hand washing training (a PowerPoint presentation through an online module)

Method - SubjectsThe subjects are randomized to

either the intervention or control group

They receive hand hygiene training accordingly.

They are told to keep their training experience confidential.

Intervention Control

Length of training 60 min Self-paced

Review of institutional hand hygiene policy

yes yes

Completion of hand hygiene exam

yes yes

Description Infection control nurse reviews policy hand hygiene policy, followed by interactive demonstration using Glo-germ™ guidelines, exam at the end

Online module, 25 powerpoint slides, exam at the end

Style One-on-one Self-directed

Description of Study Arms

Hand hygiene compliance o Using data collection instrument o Based on hospital policy: requires hand hygiene

upon entering and exiting a patient’s room Student nurses will serve as the observers

o Trained by the Infection Control Nurse on data collection and hand hygiene

o Enter hand hygiene compliance on the data collection instrument

o Will not know what trial arm the subjects are in

Outcome Measures

Data Collection Instrument

Nurse Name

Entrance: Hand Hygiene

Exit: Hand Hygiene

YES NO YES NO

Chandler III I I IIII

Joey II II III I

Ross III I I IIII

Rachel II II III I

Monica III I I IIII

Pheobe II II III I

Null hypothesis: There will be no difference in hand hygiene compliance over the course of six months between staff nurses assigned to the intervention group and the control group on an inpatient pediatric unit.

Alternate hypothesis (one tailed): Nurses in the intervention group will have a greater incidence of hand hygiene compliance than nurses in the control group over the course of six months.

Statistical Analysis

Statistical Analysis (cont.)A simple randomized sample

studyDiscrete data (yes or no, hand

hygiene)Sample size is >5Will use the Chi-Square testAlpha is set at 0.05