Feedback Helps to Clean Hands

Photo: Washing hands

Coupled feedback to personalised
action planning improved hand-
hygiene compliance by up to 18
per cent on Intensive Therapy Units;
© panthermedia.net/Tyler Olson

The Feedback Intervention Trial (FIT) is the first such trial to be done in a large number of hospitals anywhere in the world. Carried out across 60 wards in 16 hospitals the study showed that an intervention that coupled feedback to personalised action planning improved hand-hygiene compliance by up to 18 per cent on Intensive Therapy Units (ITUs) and 13 per cent on Acute Care of the Elderly (ACE) wards. It was also found that soap use increased by 30 per cent.

“This is a landmark trial, as until now there has been no randomised controlled trial evidence showing which interventions improve hand hygiene compliance in modern hospitals,” said principle investigator Doctor Sheldon Stone. “It is also the first trial to use behavioural sciences to change health care workers hand hygiene behaviour.”

Sustained improvements in hand-hygiene are key to the World Health Organisation’s SAVES LIVES strategy to reduce health-care associated infection, yet hand-hygiene compliance amongst healthcare workers remains poor, with levels of 25-40 per cent being common.

“The study suggests that the NHS should explore using the FIT intervention and learn how best to implement it, as used properly it can be a really powerful tool,” said Stone. “The intervention, which couples feedback to personalised action planning, could be included in infection control teams' audit and appraisal systems in order to reduce the burden of healthcare associated infection on hospital wards.”

The intervention process involved a four-week audit cycle, with healthcare workers observed for 20 minutes. Immediate feedback was given after the period of observation, and the person was then helped to form a personal action plan for better hand hygiene. The effect was stronger on ITUs than ACEs, where it was easier to implement. The more frequently wards carried out the intervention, the stronger its effect.

In addition to observing and measuring hand-hygiene compliance, the amount of soap and alcohol hand-rub used each month was also collected as another measure of hand-hygiene compliance for each ward. This also gave a better picture of the total weekly usage, as such data was not subject to any observational bias.

MEDICA.de; Source: University College London