Hand Hygiene Compliance: The Role of Interactive vs. Passive Education in Improving Hand Hygiene A Randomized Control Study Christine Klucznik Telana Fairchild Erica Magaziner Molly Rivest UMass - 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

Objective  To 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 randomization  Training period is 30 days  Data collection period is 6 months  Followed 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.)  Setting o Chicago, IL o Urban Hospital, 500 bed tertiary academic medical center o 28 bed Pediatric Unit with 50 staff nurses o Ratio of nurse to patient, 1:3

Method - Subjects  Entry Criteria o Must be a staff nurse on pediatric floor with direct patient contact o Must have worked on the pediatric floor for >1 year  Exclusionary Criteria o Cannot be a float or travel nurse o Cannot be a charge nurse  IRB granted waiver

 Staff nurses  License held  Years as a nurse  Hours worked per week  Shift worked  Gender Study Sample: Baseline Characteristics

Method - Subjects  Intervention – interactive learning o Participants receive a demonstration training using Glo-germ™ (hand washing UV light kit)

Method - Subjects  Control – passive learning o Participants receive the institutional standard hand washing training (a PowerPoint presentation through an online module)

Method - Subjects  The 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.

InterventionControl Length of training60 minSelf-paced Review of institutional hand hygiene policy yes Completion of hand hygiene exam yes DescriptionInfection 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 StyleOne-on-oneSelf-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 NameEntrance: Hand HygieneExit: Hand Hygiene YESNOYESNO ChandlerIIIIIIIII JoeyII IIII RossIIIIIIIII RachelII IIII MonicaIIIIIIIII PheobeII IIII

 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 study  Discrete data (yes or no, hand hygiene)  Sample size is >5  Will use the Chi-Square test  Alpha is set at 0.05