Sheldon Stone senior lecturer, Graziella Kontowski founder of Clostridium difficile support group , Rose Gallagher nurse adviser, infection prevention and control, Julie Storr president, Louise Teare consultant microbiologist and infection control doctor
Stone S, Kontowski G, Gallagher R, Storr J, Teare L.
Keeping hand hygiene high on the patient safety agenda
BMJ 2013; 346 :f2699
doi:10.1136/bmj.f2699
Re: Keeping hand hygiene high on the patient safety agenda
Sir/madam,
We thouroghly concur with Stone et al that hand hygiene still appears not to be an 'established part of clinical care' and that compliance rates can be as low as 40%. Educating health care workers in hand hygiene and a continuing change of culture are still necessary.
We have carried out a systematic review of educational interventions that impacted on hand hygiene compliance in healthcare professionals within a hospital care setting (reference). We found that educational interventions had a greater impact if compliance to hand hygiene compliance best practice was low. Multiple and or continuous interventions were better than single interventions in terms of sustaining behaviour change. However, it is uncertain as to how long a change in behaviour persists after an educational intervention. Combining the intervention with other components (reminders, incentives, checklists, surveillance, audit, and feedback) is the most effective way of reinforcing the educational message with repeated sessions fed into daily practice maintaining compliance. Using performance feedback and using internal teams to deliver interventions rather than external sources is likely to increase hand hygiene compliance.
We feel that research is now required to explore cultural, social and psychological barriers to hand hygiene compliance and to identify bespoke strategies to address these barriers and embed good educational practice within the workplace.
Grant-giving bodies have, in the past, implied to us that this work is not a priority as hand hygiene is 'an established part of clinical care' - we agree with Stone et al that this premise is still to be confirmed.
Reference
Cherry GM, BrownJM, Bethell GS, Neal T, Shaw NJ. Features of educational interventions that lead to compliance with hand hygiene in healthcare professionals within a hospital care setting. A BEME systematic review: BEME Guide No. 22. Med Teach 2012;34:e406-e420.
Competing interests: No competing interests