The role of managers in promoting good hand hygiene in a Finnish tertiary care hospital.

BACKGROUND: Hospital managers play an essential role in implementing strategies to promote good hand hygiene (HH) among health care workers. We investigated the managers' views on their roles, challenges and developmental ideas in promoting good HH practice. METHODS: A descriptive cross-sectional study with an online survey of both medical and nursing managers was conducted within a single tertiary care hospital in Finland. Three open-ended questions were analyzed using inductive content analysis. RESULTS: A total of 78 managers out of 168 responded to the survey (response rate 46%). Managers helped promote HH practices by enabling the proper environment for adherence to good HH, visible commitment, and using various means to instruct staff about HH. Challenges included the acute hospital setting and practical problems related to the managers' numerous responsibilities. Developmental ideas included information communication technology applications for monitoring HH as an indicator of the quality of care, versatile responses to HH audits, and clarifying the roles of different management levels. CONCLUSIONS: Managers are committed to and use various methods to promote HH. Managers would benefit from information communication technology applications to provide easy and targeted information regarding compliance with HH.

Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland.

OBJECTIVE: To determine changes in hand-hygiene compliance after the introduction of direct observation of hand-hygiene practice for doctors and nurses, and evaluate the relationship between the changes and the incidence of health-care-associated infections. METHODS: We conducted an internal audit survey in a tertiary-care hospital in Finland from 2013 to 2018. Infection-control link nurses observed hand-hygiene practices based on the World Health Organization's strategy for hand hygiene. We calculated hand-hygiene compliance as the number of observations where necessary hand-hygiene was practised divided by the total number of observations where hand hygiene was needed. We determined the incidence of health-care-associated infections using a semi-automated electronic incidence surveillance programme. We calculated the Pearson correlation coefficient (r) to evaluate the relationship between the incidence of health-care-associated infections and compliance with hand hygiene. FINDINGS: The link nurses made 52 115 hand-hygiene observations between 2013 and 2018. Annual hand-hygiene compliance increased significantly from 76.4% (2762/3617) in 2013 to 88.5% (9034/10 211) in 2018 (P < 0.0001). Over the same time, the number of health-care-associated infections decreased from 2012 to 1831, and their incidence per 1000 patient-days fell from 14.0 to 11.7 (P < 0.0001). We found a weak but statistically significant negative correlation between the monthly incidence of health-care-associated infections and hand-hygiene compliance (r = -0.48; P < 0.001). CONCLUSION: The compliance of doctors and nurses with hand-hygiene practices improved with direct observation and feedback, and this change was associated with a decrease in the incidence of health-care-associated infections. Further studies are needed to evaluate the contribution of hand hygiene to reducing health-care-associated infections.

Adherence to hand hygiene guidelines - significance of measuring fidelity.

AIMS AND OBJECTIVES: The aim was to evaluate the usability of fidelity measures in compliance evaluation of hand hygiene. BACKGROUND: Adherence to hand hygiene guidelines is important in terms of patient safety. Compliance measures seldom describe how exactly the guidelines are followed. DESIGN AND METHODS: A cross-sectional observation study in a university hospital setting was conducted. Direct observation by trained staff was performed using a standardised observation form supplemented by fidelity criteria. A total of 830 occasions were observed in 13 units. Descriptive statistics (frequency, mean, percentages and range) were used as well as compliance rate by using a standard web-based tool. In addition, the binomial standard normal deviate test was conducted for comparing different methods used in evaluation of hand hygiene and in comparison between professional groups. RESULTS: Measuring fidelity to guidelines was revealed to be useful in uncovering gaps in hand hygiene practices. The main gap related to too short duration of hand rubbing. Thus, although compliance with hand hygiene guidelines measured using a standard web-based tool was satisfactory, the degree of how exactly the guidelines were followed seemed to be critical. CONCLUSIONS: Combining the measurement of fidelity to guidelines with the compliance rate is beneficial in revealing inconsistency between optimal and actual hand hygiene behaviour. RELEVANCE TO CLINICAL PRACTICE: Evaluating fidelity measures is useful in terms of revealing the gaps between optimal and actual performance in hand hygiene. Fidelity measures are suitable in different healthcare contexts and easy to measure according to the relevant indicators of fidelity, such as the length of hand rubbing. Knowing the gap facilitates improvements in clinical practice.