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Hand hygiene promotion delivered by change agents—Two attitudes, similar outcome

Published online by Cambridge University Press:  13 January 2020

Yew Fong Lee ,
Mary-Louise McLaws ,
Loke Meng Ong ,
Suraya Amir Husin ,
Hock Hin Chua ,
See Yin Wong ,
Didier Pittet  and
Walter Zingg
Yew Fong Lee
Affiliation:
Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland Ministry of Health, Kuala Lumpur, Malaysia
Mary-Louise McLaws
Affiliation:
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
Loke Meng Ong
Affiliation:
Clinical Research Centre & Department of Medicine, Hospital Pulau Pinang, Georgetown, Malaysia
Suraya Amir Husin
Affiliation:
Ministry of Health, Kuala Lumpur, Malaysia
Hock Hin Chua
Affiliation:
Sarawak General Hospital, Kuching, Sarawak, Malaysia
See Yin Wong
Affiliation:
Sarawak General Hospital, Kuching, Sarawak, Malaysia
Didier Pittet
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Walter Zingg*
Affiliation:
Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Author for correspondence: Walter Zingg, E-mail: walter.zingg@hcuge.ch
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Abstract

Objective:

To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care.

Design:

Randomized-controlled study.

Setting:

Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia.

Methods:

We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours.

Results:

Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%–53%) and 50% (95% CI, 44%–55%) in the preintervention period to 66% (63%–69%) and 65% (60%–69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals.

Conclusion:

Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 3 , March 2020 , pp. 273 - 279
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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