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

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; Walter Zingg; PROHIBIT consortium

doi:10.1186/s13756-022-01148-1

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

Antimicrob Resist Infect Control. 2022 Oct 5;11(1):123. doi: 10.1186/s13756-022-01148-1.

Authors

Tjallie van der Kooi^#¹, Hugo Sax^#^{2

3}, Hajo Grundmann⁴, Didier Pittet^{5

6}, Sabine de Greeff¹, Jaap van Dissel¹, Lauren Clack², Albert W Wu⁷, Judith Davitt⁸, Sofia Kostourou⁹, Alison Maguinness¹⁰, Anna Michalik¹¹, Viorica Nedelcu¹², Márta Patyi¹³, Janja Perme Hajdinjak¹⁴, Milena Prosen¹⁴, David Tellez¹⁵, Éva Varga¹³, Fani Veini⁹, Mirosław Ziętkiewicz^{16

17}, Walter Zingg^{18

19}; PROHIBIT consortium

Affiliations

¹ RIVM National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
² Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
³ Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
⁴ Medical Center - University of Freiburg, Freiburg, Germany.
⁵ University of Geneva Hospitals, Geneva, Switzerland.
⁶ WHO Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva, Switzerland.
⁷ Center for Health Services and Outcomes Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Galway University Hospital, Galway, Ireland.
⁹ Evangelismos Hospital, Athens, Attica, Greece.
¹⁰ St. Michaels Hospital, Dún Laoghaire, Ireland.
¹¹ Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, Poland.
¹² Emergency Institute for Cardiovascular Diseases "Prof. C.C. Iliescu", Bucharest, Romania.
¹³ Bács-Kiskun Megyei Kórház (County Teaching Hospital), Kecskemet, Hungary.
¹⁴ University Medical Centre Ljubljana, Ljubljana, Slovenia.
¹⁵ Hospital Vall d'Hebron, Barcelona, Catalunya, Spain.
¹⁶ John Paul II Hospital, Kraków, Poland.
¹⁷ Medical College Jagiellonian University, Kraków, Poland.
¹⁸ Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. walter.zingg@usz.ch.
¹⁹ WHO Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva, Switzerland. walter.zingg@usz.ch.

^# Contributed equally.

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.

Keywords: Activity index; Hand hygiene; Individual; Intensive care; Intervention; Multicentre.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cross Infection* / prevention & control
Guideline Adherence
Hand Hygiene* / methods
Health Personnel
Humans
Intensive Care Units