Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE
Abstract Background Professional hand hygiene compliance represents a multifaceted behaviour with various determinants. Thus, it has been proposed to apply psychological frameworks of behaviour change to its promotion. However, randomized controlled trials of such approaches, which also assess nosoc...
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2019-03-01
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Series: | Antimicrobial Resistance and Infection Control |
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Online Access: | http://link.springer.com/article/10.1186/s13756-019-0507-5 |
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doaj-527bbcdec0054b869e9810f715696135 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas von Lengerke Ella Ebadi Bettina Schock Christian Krauth Karin Lange Jona T. Stahmeyer Iris F. Chaberny |
spellingShingle |
Thomas von Lengerke Ella Ebadi Bettina Schock Christian Krauth Karin Lange Jona T. Stahmeyer Iris F. Chaberny Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE Antimicrobial Resistance and Infection Control Hand hygiene compliance Nosocomial infections Multidrug-resistant organisms Psychological tailoring Intensive care units Physicians and nursing staff |
author_facet |
Thomas von Lengerke Ella Ebadi Bettina Schock Christian Krauth Karin Lange Jona T. Stahmeyer Iris F. Chaberny |
author_sort |
Thomas von Lengerke |
title |
Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE |
title_short |
Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE |
title_full |
Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE |
title_fullStr |
Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE |
title_full_unstemmed |
Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE |
title_sort |
impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial psygiene |
publisher |
BMC |
series |
Antimicrobial Resistance and Infection Control |
issn |
2047-2994 |
publishDate |
2019-03-01 |
description |
Abstract Background Professional hand hygiene compliance represents a multifaceted behaviour with various determinants. Thus, it has been proposed to apply psychological frameworks of behaviour change to its promotion. However, randomized controlled trials of such approaches, which also assess nosocomial infections (NIs), are rare. This study analyses data of the PSYGIENE-trial (PSYchological optimized hand hyGIENE promotion), which has shown improvements in compliance after interventions tailored based on the Health Action Process Approach (HAPA), on rates of NIs with multidrug-resistant organisms (MDROs). Methods A parallel-group cluster-randomized controlled trial was conducted on all 10 intensive care units and two hematopoietic stem cell transplantation units at Hannover Medical School, a German tertiary care hospital. Educational training sessions for physicians and nurses (individual-level intervention) and feedback discussions with clinical managers and head nurses (cluster-level) were implemented in 2013. In the “Tailoring”-arm (n = 6 wards), interventions were tailored based on HAPA-components, which were empirically assessed and addressed by behaviour change techniques. As active controls, n = 6 wards received untailored educational sessions of the local “Clean Care is Safer Care”-campaign (Aktion Saubere Hände: “ASH”-arm). From 2013 to 2015 compliance was assessed by observation following the World Health Organization, while alcohol-based hand rub usage (AHRU) and NIs with multidrug-resistant gram-negative bacteria, Methicillin-resistant Staphylococcus aureus or Vancomycin-resistant Enterococcus were assessed following national surveillance protocols. Data were analysed at cluster-level. Results In the “Tailoring”-arm, interventions led to a decrease of 0.497 MDRO-infections per 1000 inpatient days from 2013 to 2015 (p = 0.015). This trend was not found in the “ASH”-arm (− 0 . 022 infections; p = 0.899). These patterns corresponded inversely to the trends in compliance but not in AHRU. Conclusions While interventions tailored based on the HAPA-model did not lead to a significantly lower incidence rate of MDRO-infections compared to control wards, a significant reduction, compared to baseline, was found in the second follow-up year in the “Tailoring”- but not the "ASH"-arm. This indicates that HAPA-tailored hand hygiene interventions may contribute to the prevention of NIs with MDRO. Further research should focus on addressing compliance by interventions tailored not only to wards, but also leaders, teams, and individuals. Trial registration German Clinical Trials Register/International Clinical Trials Registry Platform, DRKS00010960. Registered 19 August 2016-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010960. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010960. |
topic |
Hand hygiene compliance Nosocomial infections Multidrug-resistant organisms Psychological tailoring Intensive care units Physicians and nursing staff |
url |
http://link.springer.com/article/10.1186/s13756-019-0507-5 |
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doaj-527bbcdec0054b869e9810f7156961352020-11-25T02:28:23ZengBMCAntimicrobial Resistance and Infection Control2047-29942019-03-018111110.1186/s13756-019-0507-5Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENEThomas von Lengerke0Ella Ebadi1Bettina Schock2Christian Krauth3Karin Lange4Jona T. Stahmeyer5Iris F. Chaberny6Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical PsychologyHannover Medical School, Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital EpidemiologyHannover Medical School, Centre for Public Health and Healthcare, Department of Medical PsychologyHannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems ResearchHannover Medical School, Centre for Public Health and Healthcare, Department of Medical PsychologyHannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems ResearchHannover Medical School, Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital EpidemiologyAbstract Background Professional hand hygiene compliance represents a multifaceted behaviour with various determinants. Thus, it has been proposed to apply psychological frameworks of behaviour change to its promotion. However, randomized controlled trials of such approaches, which also assess nosocomial infections (NIs), are rare. This study analyses data of the PSYGIENE-trial (PSYchological optimized hand hyGIENE promotion), which has shown improvements in compliance after interventions tailored based on the Health Action Process Approach (HAPA), on rates of NIs with multidrug-resistant organisms (MDROs). Methods A parallel-group cluster-randomized controlled trial was conducted on all 10 intensive care units and two hematopoietic stem cell transplantation units at Hannover Medical School, a German tertiary care hospital. Educational training sessions for physicians and nurses (individual-level intervention) and feedback discussions with clinical managers and head nurses (cluster-level) were implemented in 2013. In the “Tailoring”-arm (n = 6 wards), interventions were tailored based on HAPA-components, which were empirically assessed and addressed by behaviour change techniques. As active controls, n = 6 wards received untailored educational sessions of the local “Clean Care is Safer Care”-campaign (Aktion Saubere Hände: “ASH”-arm). From 2013 to 2015 compliance was assessed by observation following the World Health Organization, while alcohol-based hand rub usage (AHRU) and NIs with multidrug-resistant gram-negative bacteria, Methicillin-resistant Staphylococcus aureus or Vancomycin-resistant Enterococcus were assessed following national surveillance protocols. Data were analysed at cluster-level. Results In the “Tailoring”-arm, interventions led to a decrease of 0.497 MDRO-infections per 1000 inpatient days from 2013 to 2015 (p = 0.015). This trend was not found in the “ASH”-arm (− 0 . 022 infections; p = 0.899). These patterns corresponded inversely to the trends in compliance but not in AHRU. Conclusions While interventions tailored based on the HAPA-model did not lead to a significantly lower incidence rate of MDRO-infections compared to control wards, a significant reduction, compared to baseline, was found in the second follow-up year in the “Tailoring”- but not the "ASH"-arm. This indicates that HAPA-tailored hand hygiene interventions may contribute to the prevention of NIs with MDRO. Further research should focus on addressing compliance by interventions tailored not only to wards, but also leaders, teams, and individuals. Trial registration German Clinical Trials Register/International Clinical Trials Registry Platform, DRKS00010960. Registered 19 August 2016-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010960. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010960.http://link.springer.com/article/10.1186/s13756-019-0507-5Hand hygiene complianceNosocomial infectionsMultidrug-resistant organismsPsychological tailoringIntensive care unitsPhysicians and nursing staff |