Project

Discipline

Electronic monitoring; Hand hygiene; Alcohol-based handrub; Compliance; Feedback; Hand hygiene customization

Lead
Les infections liées aux soins (ILS) représentent un important problème de santé publique. Elles sont responsables de plusieurs centaines de millions de nouveaux cas chaque année, associées à de nombreux décès et à des dépenses supplémentaires pour la société et les systèmes de santé. On estime que les ILS concernent respectivement 7 et 10% des patients hospitalisés dans les pays développés et en développement et sont responsables de millions de décès chaque année dans le monde. Des études ont démontré que 50 à 70% de ces infections sont transmises par les mains des soignants. Par conséquent l’hygiène des mains (HM) demeure la meilleure méthode pour prévenir leur survenue.
Lay summary
L’HM semble une mesure simple mais elle est pourtant insuffisamment réalisée par les soignants, du fait principalement de la surcharge croissante de travail au lit du patient. L’objectif de notre étude est d’améliorer l’observance de l’HM (d’au moins 20%) ainsi que sa qualité. Nous aimerions tester l’effet d’un dispositif électronique qui enregistrera les pratiques d’HM des soignants et qui donnera un retour d’information en temps réel de leurs actions. Pour cela, nous allons mener une étude expérimentale comparative utilisant une méthodologie robuste et une approche pragmatique dans différents services des Hôpitaux Universitaires de Genève dont l’expérience sur la promotion de l’HM est reconnue mondialement. Nous comparerons la performance de ce dispositif à celle d’un dispositif factice ainsi qu’aux recommandations standards appliquées dans l’institution. Considérant que les ILS sont d’une importance majeure, nous sommes confiants du bénéfice qu’apportera un tel dispositif dans le domaine de la prévention des ILS ainsi que dans la promotion d’une culture de la sécurité dans les institutions de santé.

Direct link to Lay Summary

Last update: 28.09.2015

Active participation

Self-organised

Number	Title	Start	Funding scheme

1.1.BackgroundHealth care-associated infections (HAI) are a major public health problem, with an estimated hundreds of millions of new episodes occurring annually worldwide, leading to significant mortality and financial losses for health systems. They affect approximately 7% and 10% of all hospitalized patients in developed and developing countries, respectively, and are responsible for millions of deaths worldwide each year.It is well recognized that as much as 50-70% of the HAI infections episodes are transmitted or inoculated by healthcare workers’ hands due to the lack of proper hand hygiene, which remains the most efficient method to prevent its occurrence. For this reason, the World Health Organization (WHO) recommends a Multimodal Strategy to improve hand hygiene practices in the healthcare setting, which comprises 5 well defined elements: 1) providing alcohol-based handrub at the point of patient care and continuous access to hand hygiene agents and related items; 2) assuring continuous healthcare workers education on hand hygiene; 3) performing observation of hand hygiene practices and providing timely performance feedback; 4) displaying reminders in the workplace; 5) creating a safety climate within the whole institution.In that list, recommendation number 3 is one of the most challenging because evaluating hand hygiene practices by direct observation is a time-consuming and costly task which limits its universal applicability. In this sense, an electronic device intended to continuously monitor hand hygiene practices and to provide a real-time feedback to healthcare workers could be very useful, especially in the context of multimodal promotional strategies. Working hypothesisWe hypothesize that compliance with hand hygiene amongst healthcare workers may be improved by at least 20% if they receive continuous feedback about their performance on it during daily patient care.1.2.Specific aimsWe aim to identify the effectiveness of using an automatic, instantaneous, individualized feedback device in promoting hand hygiene compliance amongst healthcare workers performing patient-care activities, and, as well as, in enhancing the quality of hand hygiene action, inferred here by the volume of hand rub applied to hands and the duration of the hand rubbing procedure.1.3.MethodsThis will be a cluster randomized placebo-controlled trial in several wards at the Hôpitaux Universitaires de Genève (HUG), a large tertiary-care university hospital. The intervention will consist of wearing an electronic device intended to provide immediate, individualized feedback to healthcare workers at the point of each hand hygiene action. Feedback is provided regard the quality of his/her action in terms of duration and volume of alcohol-based handrub used, both parameters reflecting the quality of hand hygiene. In addition, the device will also record information regarding the date, hour, volume of alcohol-based handrub, and duration of each hand hygiene action performed by the healthcare worker using it. There will be two control groups: one using a sham device and another using no device at all.Our primary outcome will be the performance of hand hygiene action by the healthcare worker observed in the presence of an opportunity for hand disinfection during the course of patient care. Secondary outcomes will be the amount of alcohol-based handrub used per hand hygiene action, the duration of alcohol handrubbing, and the quality of hand hygiene action assessed by the combination of the two previous parameters. The primary outcome will be assessed using direct observation on 3 different time-periods: before the intervention, during the intervention, and after the intervention. Secondary outcomes will be continuously recorded throughout the intervention period, when the healthcare workers will be using the intervention or the sham devices.Statistical analyses will take into account some clustering in the data at the ward level and generalized linear mixed models with a random effect on the intercept at ward level will be performed.1.4.Expected value of the proposed projectConsidering HAI as a major public health problem, the device to be studied here may promote both compliance and quality of hand hygiene behaviour amongst healthcare workers on a contual basis, contributing to hospital safety culture and infection prevention.