Differences in observed and self-reported compliance with 'Five Moments for Hand Hygiene' as a function of the empathy of healthcare workers.

BACKGROUND: Hand hygiene at critical time-points (as established by the World Health Organization's model 'Five Moments for Hand Hygiene') remains the leading measure for minimizing the risk of healthcare-associated infections. While many interventions have been tested to improve hand hygiene compliance (HHC) of healthcare workers (HCWs), little is known about the relationship between HHC and empathy of HCWs. AIM: To investigate the relationship between moment-specific HHC rates and empathy of HCWs at both individual and ward levels. METHODS: HHC data were collected via observation and self-report, and empathy levels were measured using an established questionnaire. The survey was conducted on 38 wards of three tertiary care hospitals in Germany. Observation data were obtained via in-house observations conducted ≤8 months before or after the survey. FINDINGS: Evidence for the expected correlation between empathy of HCWs and moment-specific HHC was found for both observed HHC (Moment 1: r=0.483, P=0.031; Moment 2: r=588, P=0.006) and self-reported HHC (Moment 1: r=0.093, P=0.092; Moment 2: r=0.145, P=0.008). In analyses of variance, the critical interaction effect between empathy (i.e. lower vs higher empathy) and designated time-point of hand hygiene (i.e. before vs after reference task) was also significant. CONCLUSION: Empathy of HCWs should be considered as an important factor in explaining differences between moment-specific HHC rates. In consequence, empathy comes into focus not only as a crucial factor for high-quality patient care, but also as an important contributor to improving HHC.

A quasi-randomized controlled before-after study using performance feedback and goal setting as elements of hand hygiene promotion.

BACKGROUND: Hand hygiene (HH) plays an important role in infection prevention but is often suboptimal. AIM: To test the potential of goal setting and performance feedback in improving HH. METHODS: A prospective controlled intervention study was conducted at a German hospital. The study involved four phases: habituation to novel count dispensers and observers (T0), baseline (T1), intervention (T2) and postintervention (T3). Four non-intensive-care units were assigned to one of four conditions: goal setting, performance feedback, both goal setting and performance feedback, or none (control). During all phases, dispenser usage was electronically recorded 24/7. In addition, randomly sampled direct observation was conducted by trained external observers during each phase. The main outcome measure was the daily average of electronically counted hand hygiene events (HHEs) per patient room. FINDINGS: In the feedback condition, a marginally significant increase in HHEs was found from T1 to T2 (MT1 = 7.3, MT2 = 10.3, MT3 = 8.2). In the goal-setting condition, HHEs increased only descriptively from T1 to T2 (MT1 = 6.8, MT2 = 8.7, MT3 = 7.8). In the combined condition, HHEs increased significantly from T1 to T2, and were still significantly elevated at T3 (MT1 = 7.9, MT2 = 17.0, MT3= 12.9). Over all wards and study phases, count dispenser usage frequency was highly correlated with HH compliance (ρ = 0.766, P<0.001). CONCLUSION: This study suggests that combining goal setting and feedback is a useful approach for improving HH.