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Impact of using a device providing individual feedback on healthcare workers hand hygiene behaviour: a cluster randomized clinical trial

English title Impact of using a device providing individual feedback on healthcare workers hand hygiene behaviour: a cluster randomized clinical trial
Applicant Pittet Didier
Number 163262
Funding scheme Project funding (Div. I-III)
Research institution Serv. Prévention et Contrôle de l’Infection Direction médicale HUG
Institution of higher education University of Geneva - GE
Main discipline Methods of Epidemiology and Preventive Medicine
Start/End 01.04.2016 - 31.03.2019
Approved amount 525'000.00
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All Disciplines (4)

Discipline
Methods of Epidemiology and Preventive Medicine
Infectious Diseases
Occupational Medicine, Ergonomy
Public Health and Health Services

Keywords (6)

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

Lay Summary (French)

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

Responsible applicant and co-applicants

Employees

Publications

Publication
Scenario-based simulation training for the WHO hand hygiene self-assessment framework
Tartari Ermira, Fankhauser Carolina, Peters Alexandra, Sithole Buyiswa Lizzie, Timurkaynak Funda, Masson-Roy Sarah, Allegranzi Benedetta, Pires Daniela, Pittet Didier (2019), Scenario-based simulation training for the WHO hand hygiene self-assessment framework, in Antimicrobial Resistance & Infection Control, 8(1), 58-58.
Hand hygiene in hospitals: anatomy of a revolution
Vermeil T., Peters A., Kilpatrick C., Pires D., Allegranzi B., Pittet D. (2019), Hand hygiene in hospitals: anatomy of a revolution, in Journal of Hospital Infection, 101(4), 383-392.
Control of Carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii , and Pseudomonas aeruginosa in Healthcare Facilities: A Systematic Review and Reanalysis of Quasi-experimental Studies
Tomczyk Sara, Zanichelli Veronica, Grayson M Lindsay, Twyman Anthony, Abbas Mohamed, Pires Daniela, Allegranzi Benedetta, Harbarth Stephan (2019), Control of Carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii , and Pseudomonas aeruginosa in Healthcare Facilities: A Systematic Review and Reanalysis of Quasi-experimental Studies, in Clinical Infectious Diseases, 68(5), 873-884.
Promoting and sustaining a historical and global effort to prevent sepsis: the 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign
Martischang Romain, Pires Daniela, Masson-Roy Sarah, Saito Hiroki, Pittet Didier (2018), Promoting and sustaining a historical and global effort to prevent sepsis: the 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign, in Critical Care, 22(1), 92-92.
Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review
Abbas Mohamed, Pires Daniela, Peters Alexandra, Morel Chantal M, Hurst Samia, Holmes Alison, Saito Hiroki, Allegranzi Benedetta, Lucet Jean-Christophe, Zingg Walter, Harbarth Stephan, Pittet Didier (2018), Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review, in Intensive Care Medicine, 44(10), 1679-1690.
Antibacterial efficacy of handrubbing for 15 versus 30 seconds: EN 1500-based randomized experimental study with different loads of Staphylococcus aureus and Escherichia coli
Pires D., Soule H., Bellissimo-Rodrigues F., de Kraker M.E.A., Pittet D. (2018), Antibacterial efficacy of handrubbing for 15 versus 30 seconds: EN 1500-based randomized experimental study with different loads of Staphylococcus aureus and Escherichia coli, in Clinical Microbiology and Infection, 10.
Let's prevent sepsis in health care – The 5 May 2018 World Health Organization (WHO) SAVE LIVES: Clean Your Hands campaign
Peters Alexandra, Saito Hiroki, Borzykowski Tcheun, Kilpatrick Claire, Allegranzi Benedetta, Pittet Didier (2018), Let's prevent sepsis in health care – The 5 May 2018 World Health Organization (WHO) SAVE LIVES: Clean Your Hands campaign, in Journal of Infection, 76(6), 563-569.
Preventing sepsis in healthcare – 200 years after the birth of Ignaz Semmelweis
Pittet Didier, Allegranzi Benedetta (2018), Preventing sepsis in healthcare – 200 years after the birth of Ignaz Semmelweis, in Eurosurveillance, 23(18), 18.
“It's in your hands—prevent sepsis in health care”; May 5 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign
Saito Hiroki, Borzykowski Tcheun, Kilpatrick Claire, Pires Daniela, Allegranzi Benedetta, Pittet Didier (2018), “It's in your hands—prevent sepsis in health care”; May 5 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign, in American Journal of Infection Control, 46(5), 480-481.
2018 WHO hand hygiene campaign: preventing sepsis in health care and the path to universal health coverage
Saito Hiroki, Allegranzi Benedetta, Pittet Didier (2018), 2018 WHO hand hygiene campaign: preventing sepsis in health care and the path to universal health coverage, in The Lancet Infectious Diseases, 18(5), 490-492.
Healthcare-associated sepsis and the role of clean hands: When we do not see the trees for the forest
Peters Alexandra, Masson-Roy Sarah, Pittet Didier (2018), Healthcare-associated sepsis and the role of clean hands: When we do not see the trees for the forest, in International Journal of Infectious Diseases, 70, 101-103.
The WHO 2018 Hand Hygiene Campaign: Make a Difference—Prevent Sepsis in Health Care
Masson-Roy Sarah, Saito Hiroki, Pittet Didier (2018), The WHO 2018 Hand Hygiene Campaign: Make a Difference—Prevent Sepsis in Health Care, in American Journal of Respiratory and Critical Care Medicine, 197(8), 985-986.
The 2018 World Health Organization SAVE LIVES: Clean Your Hands Campaign targets sepsis in health care
Saito Hiroki, Kilpatrick Claire, Pittet Didier (2018), The 2018 World Health Organization SAVE LIVES: Clean Your Hands Campaign targets sepsis in health care, in Intensive Care Medicine, 44(4), 499-501.
‘One size does not fit all’ – customizing hand hygiene agents, messages, and interventions
Tartari E., Pires D. (2018), ‘One size does not fit all’ – customizing hand hygiene agents, messages, and interventions, in Journal of Hospital Infection, 98(4), 324-327.
Why language matters: a tour through hand hygiene literature
Pires Daniela, Tartari Ermira, Bellissimo-Rodrigues Fernando, Pittet Didier (2017), Why language matters: a tour through hand hygiene literature, in Antimicrobial Resistance & Infection Control, 6(1), 65-65.
Clean Your Hands 5th May 2017: 'Fight antibiotic resistance - it's in your hands'
Tartari Ermira, Pires Daniela, Pittet Didier (2017), Clean Your Hands 5th May 2017: 'Fight antibiotic resistance - it's in your hands', in Antimicrobial Resistance & Infection Control, 6(1), 39-39.
The Effect of Participating in a Surgical Site Infection (SSI) Surveillance Network on the Time Trend of SSI Rates: A Systematic Review
Abbas Mohamed, Tartari Ermira, Allegranzi Benedetta, Pittet Didier, Harbarth Stephan (2017), The Effect of Participating in a Surgical Site Infection (SSI) Surveillance Network on the Time Trend of SSI Rates: A Systematic Review, in Infection Control & Hospital Epidemiology, 38(11), 1364-1366.
Preventing sepsis in health care – It’s in your hands: A World Health Organization call to action
Kilpatrick Claire, Saito Hiroki, Allegranzi Benedetta, Pittet Didier (2017), Preventing sepsis in health care – It’s in your hands: A World Health Organization call to action, in Journal of Infection Prevention, 19(3), 104-106.
‘Fight Antibiotic Resistance—It’s in Your Hands’: Call From the World Health Organization for 5th May 2017
Pires Daniela, de Kraker Marlieke Elizabeth Adriana, Tartari Ermira, Abbas Mohamed, Pittet Didier (2017), ‘Fight Antibiotic Resistance—It’s in Your Hands’: Call From the World Health Organization for 5th May 2017, in Clinical Infectious Diseases, 64(12), 1780-1783.
Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study
Bellissimo-Rodrigues Fernando, Pires Daniela, Soule Hervé, Gayet-Ageron Angèle, Pittet Didier (2017), Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study, in Infection Control & Hospital Epidemiology, 38(5), 553-558.
Hand Hygiene With Alcohol-Based Hand Rub: How Long Is Long Enough?
Pires Daniela, Soule Hervé, Bellissimo-Rodrigues Fernando, Gayet-Ageron Angèle, Pittet Didier (2017), Hand Hygiene With Alcohol-Based Hand Rub: How Long Is Long Enough?, in Infection Control & Hospital Epidemiology, 38(5), 547-552.
Hand hygiene: From research to action
Pittet Didier (2017), Hand hygiene: From research to action, in Journal of Infection Prevention, 18(3), 100-102.
Hand hygiene electronic monitoring: Are we there yet?
Pires Daniela, Pittet Didier (2017), Hand hygiene electronic monitoring: Are we there yet?, in American Journal of Infection Control, 45(5), 464-465.
Clean your hands on May 5, 2017: Fight antibiotic resistance—it's in your hands
Tartari Ermira, Pires Daniela, Pittet Didier (2017), Clean your hands on May 5, 2017: Fight antibiotic resistance—it's in your hands, in American Journal of Infection Control, 45(4), 342-342.
Hand hygiene mantra: teach, monitor, improve, and celebrate
Pires D., Pittet D. (2017), Hand hygiene mantra: teach, monitor, improve, and celebrate, in Journal of Hospital Infection, 95(4), 335-337.
Revisiting the WHO “How to Handrub” Hand Hygiene Technique: Fingertips First?
Pires Daniela, Bellissimo-Rodrigues Fernando, Soule Hervé, Gayet-Ageron Angèle, Pittet Didier (2017), Revisiting the WHO “How to Handrub” Hand Hygiene Technique: Fingertips First?, in Infection Control & Hospital Epidemiology, 38(2), 230-233.
Role of parents in the promotion of hand hygiene in the paediatric setting: a systematic literature review
Bellissimo-Rodrigues F., Pires D., Zingg W., Pittet D. (2016), Role of parents in the promotion of hand hygiene in the paediatric setting: a systematic literature review, in Journal of Hospital Infection, 93(2), 159-163.

Collaboration

Group / person Country
Types of collaboration
Fernando Bellissimo-Rodrigues, MD, PhD,/Ribeirão Preto Medical School - University of São Paulo Brazil (South America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Andrew Stewardson, MD/Hand Hygiene Australia, Department of Mecicine, University of Melbourne Australia (Oceania)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
26th European Congress of Clinical Microbiology and Infectious Diseases. Talk given at a conference Revisiting the WHO “How to handrub” standard technique. 09.04.2019 Amesterdam, Netherlands Gayet-Ageron Angèle; Pittet Didier; da Costa Pires Maria Daniela;
Scientific meeting of the Infectious Diseases Department of the University Hospitals of Geneva Individual talk Hand hygiene again and again. 21.12.2017 Geneva, Switzerland Pittet Didier; da Costa Pires Maria Daniela; Fankhauser Carolina Maria; Tartari Ermira; Gayet-Ageron Angèle;
23éme Journée Romande d’Hygiène Hospitalaière Individual talk Friction des mains : quand, combien, comment ? 30.11.2017 Montreaux, Switzerland Gayet-Ageron Angèle; da Costa Pires Maria Daniela; Pittet Didier;
4th International Conference on Prevention & Infection Control. Individual talk Hand Hygiene Hands-on: Compliance monitoring and validation of the observers 20.06.2017 Geneva, Switzerland da Costa Pires Maria Daniela; Pittet Didier; Fankhauser Carolina Maria;
4th International Conference on Prevention & Infection Control Poster Optimizing the hand hygiene action: 15 seconds with a hand size-customized volume. 20.06.2017 Geneva, Switzerland Pittet Didier; da Costa Pires Maria Daniela; Gayet-Ageron Angèle;
Cross transmission revisited How much is too much on your hands? Individual talk 4th International Conference on Prevention & Infection Control 20.06.2017 Geneva, Switzerland Gayet-Ageron Angèle; Pittet Didier; da Costa Pires Maria Daniela;
American Society of Microbiology Microbe 2016 Congress. Talk given at a conference Hand Hygiene with Alcohol-Based Handrub: How Long is Long Enough? 22.06.2016 Boston, United States of America da Costa Pires Maria Daniela; Pittet Didier; Gayet-Ageron Angèle;
American Society of Microbiology Microbe 2016 Congress Talk given at a conference Assessing the Risk of Hand-to-Hand Transmission of Bacteria. 22.06.2016 Boston, United States of America Gayet-Ageron Angèle; da Costa Pires Maria Daniela; Pittet Didier;
Madinah Conference of Infection Prevention and Control. Individual talk Hand hygiene electronic monitoring technologies 16.05.2016 Madinah, Saudi Arabia da Costa Pires Maria Daniela; Pittet Didier;


Self-organised

Title Date Place
Alcohol-based Handrub Taskforce. 23.06.2017 Geneva, Switzerland

Associated projects

Number Title Start Funding scheme
122324 Effectiveness of different strategies to improve hand hygiene and reduce healthcare-associated infections: a cluster randomised controlled trial 01.04.2009 Project funding (Div. I-III)

Abstract

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.
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