Hand-Hygiene Among Healthcare Workers: Upping the Odds

A major three-year trial led by researchers at UCL, in partnership with the Health Protection Agency, has shown that giving one-on-one feedback to healthcare workers makes them twice as likely to clean their hands with soap.

The Feedback Intervention Trial (FIT) is the first such trial to be done in a large number of hospitals anywhere in the world. It was carried out across 60 wards in 16 different hospitals that were already trying to implement a "clean your hands" campaign. The study showed that an intervention that tailored feedback to personalized action planning improved hand-hygiene compliance by up to 18% on Intensive Therapy Units (ITUs) and 13% on Acute Care of the Elderly (ACE) wards. It was also found that soap use increased by 30%

The study has been published in PLOS ONE, and the main findings will be presented at a national hand hygiene summit held by GovToday on Wednesday 24th October to address national hand hygiene strategy, following the discontinuation of the Clean Your Hands campaign.

"This is a landmark trial, as until now there has been no randomised controlled trial evidence showing which interventions improve hand hygiene compliance in modern hospitals," said principle investigator Dr Sheldon Stone (UCL Medical School at the Royal Free Hospital). "It is also the first trial to use behavioural sciences to change health care workers hand hygiene behaviour."

Continual improvements in hand-hygiene are key to the World Health Organization's "Save Lives" strategy to reduce health-care associated infection, yet hand-hygiene compliance among healthcare workers remains poor, with levels of 25-40% being quite common.

"The study suggests that the NHS should explore using the FIT intervention and learn how best to implement it, as used properly it can be a really powerful tool," said Dr Stone. "The intervention, which couples feedback to personalised action planning, could be included in infection control teams' audit and appraisal systems in order to reduce the burden of healthcare associated infection on hospital wards."

The intervention process involves a four week audit cycle, with healthcare workers observed for 20 minutes. Immediate feedback was given after the period of observation, and the person was then coached through a personal action plan for better hand hygiene. The effect was stronger on ITUs than ACEs, where it was easier to implement. The more frequently wards executed the intervention, the stronger its effect was.

Besides observing and measuring hand-hygiene compliance, the amount of soap and alcohol hand-rub used each month was also collected as another measure of hand-hygiene compliance for each ward. This also provided a better picture of the total weekly usage, as such data was not subject to any observational bias.

"Although audit and feedback is often suggested as a way of improving hand hygiene, this study puts its use on a firmer footing than previous non-randomised studies, providing the strongest evidence yet that this is an effective way to improve hand hygiene when coupled with a repeating cycle of personalised goal-setting and action planning," said Dr Stone.