A nudge intervention to improve hand hygiene compliance in the hospital.

Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

[The measurement of nursing workload in a sub-intensive unit with the Nine Equivalents of Nursing Manpower Scale]. / Rilevazione dei carichi di lavoro in un reparto di terapia sub-intensiva attraverso la scala Nine Equivalents of Nursing Manpower.

SUMMARY: The measurement of nursing workload in a sub-intensive unit with the Nine Equivalents of Nursing Manpower Scale. INTRODUCTION: The need to maximize the nursing manpower to patients complexity requires a careful assessment of the nursing workload. AIMS: To measure the nursing workload in a sub-intensive care unit and to assess the impact of patients isolated for multidrug resistant microorganisms (MDR) and with delirium, on the nursing workload. METHODS: From december 1 2014 to march 31 2015 the nursing workload of patients admitted to a semi intensive untit of a Turin Hospital was measured with Nine Equivalents of Nursing Manpower (NEMS) original and modified, adding 1 point score for patients isolated and with delirium (Richmond Agitation Sedation Scale). Admission and discharge times, and the activities performed in and out of the unit were registered. RESULTS: Two-hundred-thirty patients were daily assessed and no differences were observed in mean NEMS scores with the original and modified scale: december 17.3 vs 18.5; January 19.4 vs 20.2; February 19.9 vs 20.6; March 19.5 vs 20.1). mean scores did not change across shifts although on average 8 days a month the scores exceeded 21, identifiyng an excess workload and a need of a 2:1 patient/nurse ratio. The maximum workload was concentrated between 12.00 and 18.00 pm. CONCLUSIONS: The NEMS scale allows to measure the nursing workload. Apparently patients isolated and with delirium did not significantly impact on the nursing workload.