Low-cost Intervention Leading to Increased Adherence to Hand Hygiene Practices
Ana Carolina Carvalho, Cinthia Kioki, Eliane Francelino, Marcelo Milone SilvaAbstract
Background
Adherence to hand hygiene practices is one of the most important measures for healthcare associated infections (HAIs) control. Behavioral change can be difficult to achieve and traditionally requires continuing education efforts. World Health Organization (WHO) establishes the 5 moments in which a healthcare provider must practice hand hygiene: before touching a patient, before aseptic procedure, after body fluid exposure, after touching a patient and after touching patient surroundings. Traditionally, direct observation of hand hygiene practices provides higher adherence rates than remote observation, due to Hawthorne effect, which may not reflect staff true daily practices. Thus, we decided to evaluate a low-cost intervention effect on hand hygiene adherence rates to WHO 5 moments using a remote system.
Methods
WHO 5 moments hand hygiene adherence rates in one inpatient unit at our hospital was monitored remotely via cameras pre- and post-intervention. In January 2024, the intervention was implemented. It consisted of a management-supported campaign highlighting the employees with the highest adherence to hand hygiene practices on a board posted on internal messaging groups and during the monthly hospital infection control committee meeting, who also received a certificate and chocolates as a gift. The employees with the worst adherence rates had their names forwarded to management for individual approach.
Results
The 12-month average adherence rate to hand hygiene practices in the inpatient unit before the intervention measures were implemented was 61.5% (range variation 40-74%) and after the intervention was implemented it increased to 83,3% (range variation 66-90%).
Conclusions
Despite the difficulties in motivating staff for hand hygiene activities that we had been encountering before, the use of a low-cost strategy proved effective in our setting to increase adherence to hand hygiene practices observed through a remote monitoring system.