Goal setting and feedback improve hand hygiene in hospitals

OPHARDT Hygiene Monitoring System® part of a comprehensive study.

Antibiotic resistance is an increasing global concern and as a result hand hygiene plays an important role for patient protection within medical facilities. However, numerous studies have shown that compliance with hygienic hand disinfection needs to be greatly improved.

National and international institutions, such as the World Health Organization (WHO), recommend the implementation of a multimodal strategy to ensure that medical staff is frequently using disinfectant dispensers while working. Targeted feedback is a core component of this comprehensive approach which also includes optimized availability of disinfectants at the point-of-care and regular training for medical professionals.

Currently, direct observation of hospital staff is often used to evaluate the hygiene compliance of doctors and nursing staff or to report back afterwards. However, the observer influences the results and the disinfection behaviour observed can be misleading due to the knowledge that one is being studied, also known as the “Hawthorne effect”. In addition, direct observation is time-consuming, so that often only a small sample size can be determined.

This is where the advantages of electronic monitoring systems come into play. Continuous and fully automatically, intelligent disinfectant dispensers record the hand hygiene behaviour “on the ward” – without observer bias. The hygiene data collected can thus be reported back to the hospital staff promptly and with little effort.

Psychological aspects of hand hygiene

A recently published study made use of the Ophardt Hygiene Monitoring System® (OHMS) and investigated the feedback. The scientists also investigated whether an objective and its visual representation had a long-term effect on hygiene behaviour. Past research results from other areas of the health care system potentially show positive effects on a sustainable change in behaviour. [1]

This comprehensive study on the effect of feedback and goal setting on hand hygiene compliance was conducted over several months. A total of 92 Wi-Fi-capable ingo-man® plus Weco disinfectant dispensers recorded the number of hand disinfection during the entire study period. Direct observation was also used to help calculate hand hygiene compliance.

Methodology

The study was divided into four sections (goal setting, feedback, goal setting + feedback and control), each of which was assigned to one hospital ward of the hospital. After installation of the disinfectant dispensers, the study started with a four-week familiarization phase, followed by an equally long basic survey.

Intervention phase: goals defined, feedback monitors installed

At the beginning of the intervention phase, goal setting for hand hygiene compliance were defined in the sections “Goal setting” and “Goal setting + Feedback” within the framework of team meetings and on the basis of the baseline survey. The defined goals were published on the notice boards of the respective stations. In the study arms “Feedback” and “Goal Setting + Feedback” the installation of feedback monitors followed, on which the average hand hygiene compliance of the last seven days was permanently displayed during the intervention phase. The six-week intervention was followed by a final four-week post-intervention phase without goal setting and monitors to assess the sustainable effects of the measures previously implemented.

Combined measures most effective

The results of the study show that the combination of goal setting and feedback can result in significantly more hand disinfections per day. The integration of a prominently placed monitor to display the number of hand disinfection performed, and the percentage of target achieved is an effective component of infection protection. In general, the psychological approach to improving hand hygiene compliance in medical facilities of hospital hygiene is growing in importance and should always be considered within the framework of the multimodal approach.

The OPHARDT Hygiene Monitoring System®offers all technical prerequisites for the practical implementation of comparable projects and fits perfectly into the existing work processes of hospital staff.

Source: Diefenbacher, S., Fliss, P. M., Tatzel, J., Wenk, J., & Keller, J. (2019). A quasi-randomized controlled before-after study using performance feedback and goal setting as elements of hand hygiene promotion. Journal of Hospital Infection.

[1] McEwan, D., Harden, S. M., Zumbo, B. D., Sylvester, B. D., Kaulius, M., Ruissen, G. R., … & Beauchamp, M. R. (2016). The effectiveness of multi-component goal setting interventions for changing physical activity behaviour: a systematic review and meta-analysis. Health psychology review, 10(1), 67-88.