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|Compliance bei händehygienischen Maßnahmen auf Intensivstationen|
|Main title||Compliance bei händehygienischen Maßnahmen auf Intensivstationen|
|Subtitle||Ergebnisse einer kontrollierten Interventionsstudie|
|Title variations||Compliance with hand hygiene measures at intensive care units|
|Subtitle for translated title||results of a controlled intervention survey|
Place of birth: Wriezen
|1. Referee||Prof. Dr. med. H. Rüden|
|Further Referee(s)||Prof. Dr. med. P. Gastmeier
Prof. Dr. med. S. Lemmen
|Keywords||compliance; hand hygiene; intervention|
|Classification (DDC)||610 Medical sciences; Medicine|
|Summary||Transmission of microorganism via hands of health care workers (HCWs) is the main cause of nosocomial infections in hospitals. Adequate hand hygiene can prevent the spread of infection; however, compliance with recommended hand hygiene measures remains poor.
This investigation tested the compliance of recommended hand hygiene measures in a directly observational survey as part of a prospective and controlled intervention survey.
The aim was to control a possible increase of compliance of the personnel on six different medical intensive units (ICUs) in a university hospital. Three of the six ICUs represented the intervention group and three ICUs constituted the control group. The intervention measure was quick and frequent performance feedback concerning transmission of health care associated pathogens. The pathogens were typed by PCR.
HCWs were monitored during two periods of routine patient care, before and after intervention, with regard to compliance with hand hygiene measures in all relevant care activities according to the published guidelines (n= 2.142). HCWs were informed of being observed.
The following issues were examined:
1. How high is the rate of compliance with recommended hand hygiene measures in the selected ICUs?
2. Does a performance feedback based intervention lead to increased compliance?
3. Does such an intervention lead to a change in behavior of HCWs with regard to hand hygiene procedures and relevant care activities?
4. Do the variables of gender or professional group (nursing staff, physicians, other HCWs) affect compliance?
The data collected was statistically analyzed and evaluated.
1. The overall rate of compliance was 57.0% in the first period and 61.6% in the second period (p < 0.001).
2. Feedback based intervention led to a moderate increase in compliance in both the intervention and control groups. There was therefore no advantage to performance feedback as improvement was equal in both groups (intervention group 8.8 percentage points (14.7%) (p = 0.003), control group 8.5 percentage points (15.7%) (p = 0.005)).
3. Intervention did not cause a statistically significant effect regarding the different hand hygiene procedures. There was an increase in all hand hygiene procedures evaluated to be compliant in the second observation period. However, the number of failure to perform hand hygiene activities remained consistently high even after intervention.
As regards the relevant care activities, significant results were only shown in some aspects. It was found that HCWs are more likely to carry out hand hygiene measures after patient care than before. A demonstrable positive effect (p <0.001) of intervention was shown on compliance after relevant care activities, but not before. Nevertheless, intervention can at best be considered a partial success as only hand hygiene activities that are performed before relevant care activities can significantly reduce the risk of infection to the patient.
4. The analysis of gender distribution showed no statistically significant differences. With respect to the professional groups, a statistically significant positive effect of intervention was only demonstrated for nursing staff.
A multivariate logistic regression analysis was performed in order to identify significant factors influencing compliance. A significant odds ratio was identified for the comparison between the first and the second periods and for the implementation of hand hygiene measures after relevant care activities (for both the intervention and the control groups).
Further studies with optimized interventions are necessary to improve compliance with hand hygiene measures and therefore reduce the risk of nosocomial infections.
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|FU Department||Department of Medicine - Charité - University Medicine Berlin|
|Year of publication||2012|
|Document type||Doctoral thesis|
|Date of defense||2012-02-24|
|Created at||2012-01-25 : 01:50:13|
|Last changed||2012-01-25 : 01:54:40|