DOI: 10.1177/17449871261445385 ISSN: 1744-9871

Feasibility and barriers to implementing a nurse-led hand hygiene intervention in intensive care units: a mixed-methods study

Ibtisam M Al-Zaru, Abdul-Monim Batiha, Saleh Moh’d Daradkeh, Fadwa Alhalaiqa, Anas H Khalifeh, Suad Elsayed Elsaman, Ahmed Rajeh Saifan
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Background:

Hand hygiene (HH) is essential for infection prevention, but compliance in intensive care units (ICUs) often falls short of recommended standards. Leadership-driven audit and feedback could enhance compliance, though its practicality in resource-limited, high-acuity settings is still unclear.

Aim:

To evaluate the feasibility of a nurse-led, real-time HH audit and feedback intervention in ICUs and to explore contextual barriers influencing its implementation.

Methods:

A mixed-methods study was conducted over 6 weeks in two Jordanian ICUs. Fourteen supervisors were trained to deliver digital HH audits and real-time feedback. A total of 128 HH observations were recorded pre- and post-intervention, and qualitative data were obtained through post-intervention semi-structured interviews with 22 supervisors.

Results:

HH compliance increased from 63.5% to 89.5% ( p  < 0.001; Cohen’s d  = 1.29). However, qualitative findings revealed that the intervention was not implemented as intended. Supervisors identified four major barriers: competing workload demands, technological challenges, role ambiguity and lack of managerial reinforcement. Compliance gains were instead attributed to contextual influences, including heightened awareness, peer accountability and observational effects.

Conclusions:

In resource-limited ICUs, HH improvement efforts should prioritise low-burden, context-sensitive strategies that leverage peer accountability, observational effects and organisational support mechanisms.

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