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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