Impact of direct hand hygiene observations and feedback on hand hygiene compliance among nurses and doctors in medical and surgical wards: an eight-year observational study

Abstract

Background: The improvement of hand hygiene compliance (HHC) is vital for preventing healthcare-associated infections (HAIs).

Aim: To determine whether observation and feedback influences HHC among nurses and doctors in surgical and medical wards, and whether these actions impact HAI incidence.

Methods: In this longitudinal observational study, HHC and the incidence of HAIs were observed in six medical and seven surgical wards in a tertiary hospital in Finland from May 2013 to December 2020. Data of the observations of five hand hygiene (HH) moments were collected from the hospital HH and the HAI monitoring registries. For statistical analyses a multivariable logistic regression analysis and a Poisson regression model were used.

Findings: HH monitoring included 24,614 observations among nurses and 6396 observations among doctors. In medical wards, HHC rates increased 10.8%, from 86.2% to 95.5%, and HAI incidence decreased from 15.9 to 13.5 per 1000 patient-days (P < 0.0001). In surgical wards, HHC increased 32.7%, from 67.6% to 89.7%, and HAI incidence decreased from 13.7 to 12.0 per 1000 patient-days (P < 0.0001). The overall HHC increased significantly among nurses (17.8%) and doctors (65.8%). The HHC was better among nurses than doctors (in medical wards, OR: 3.36; 95% CI: 2.90-3.90; P < 0.001; and in surgical wards, OR: 9.85; 95% CI: 8.97-10.8; P < 0.001).

Conclusion: Direct observations and feedback of HH increased HHC significantly among nurses and doctors over an eight-year period. During the same period, the incidence of HAIs significantly decreased in both medical and surgical wards.

Keywords: Feedback; Hand hygiene; Healthcare-associated infection; Infection prevention; Observation.