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Do Peer Effects Improve Hand Hygiene Adherence among Healthcare Workers?

  • Mauricio N. Monsalve (a1), Sriram V. Pemmaraju (a1), Geb W. Thomas (a2), Ted Herman (a1), Alberto M. Segre (a1) and Philip M. Polgreen (a3)...
Abstract
Objective.

To determine whether hand hygiene adherence is influenced by peer effects and, specifically, whether the presence and proximity of other healthcare workers has a positive effect on hand hygiene adherence

Design.

An observational study using a sensor network.

Setting.

A 20-bed medical intensive care unit at a large university hospital.

Participants.

Hospital staff assigned to the medical intensive care unit.

Methods.

We deployed a custom-built, automated, hand hygiene monitoring system that can (1) detect whether a healthcare worker has practiced hand hygiene on entering and exiting a patient’s room and (2) estimate the location of other healthcare workers with respect to each healthcare worker exiting or entering a room.

Results.

We identified a total of 47,694 in-room and out-of-room hand hygiene opportunities during the 10-day study period. When a worker was alone (no recent healthcare worker contacts), the observed adherence rate was 20.85% (95% confidence interval [CI], 19.78%–21.92%). In contrast, when other healthcare workers were present, observed adherence was 27.90% (95% CI, 27.48%–28.33%). This absolute increase was statistically significant (P < .01). We also found that adherence increased with the number of nearby healthcare workers but at a decreasing rate. These results were consistent at different times of day, for different measures of social context, and after controlling for possible confounding factors.

Conclusions.

The presence and proximity of other healthcare workers is associated with higher hand hygiene rates. Furthermore, our results also indicate that rates increase as the social environment becomes more crowded, but with diminishing marginal returns.

Infect Control Hosp Epidemiol 2014;35(10):1277–1285

Copyright
Corresponding author
MPH, Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242 (philip-polgreen@uiowa.edu).
References
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1. Boyce, JM, Pittet, D. Guidelines for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infect Control Hosp Epidemiol 2002;23:S3S41.
2. Erasmus, V, Daha, TJ, Brug, H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31(3):283294.
3. Pittet, D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis 2001;7:234240.
4. Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141(1):18.
5. Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160(7):10171021.
6. Kaplan, LM, McGuckin, M. Increasing handwashing compliance with more accessible sinks. Infect Control 1986;7:408410.
7. Pittet, D, Mourouga, P, Perneger, TV, et al. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126130.
8. Bittner, MJ, Rich, EC, Turner, PD, Arnold, WH Jr. Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit. Infect Control Hosp Epidemiol 2002;23:120126.
9. Pittet, D. Promotion of hand hygiene: magic, hype, or scientific challenge? Infect Control Hosp Epidemiol 2002;23:118119.
10. Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Orellano, PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31(2):8592.
11. Talbot, TR, Johnson, JG, Fergus, C, et al. Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives. Infect Control Hosp Epidemiol 2013;34(11):11291136.
12. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356(9238):13071312.
13. Kohli, E, Ptak, J, Smith, R, Taylor, E, Talbot, EA, Kirkland, KB. Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infect Control Hosp Epidemiol 2009;30(3):222225
14. Eckmanns, T, Besser, J, Behnke, M, Gastmeier, P, Rüden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931934.
15. Maury, E, Moussa, N, Lakermi, C, Barbut, F, Offenstadt, G. Compliance of health care workers to hand hygiene: awareness of being observed is important. Intensive Care Med 2006;32(12):20882089.
16. Chen, LF, Carriker, C, Staheli, R, et al. Observing and improving hand hygiene compliance: implementation and refinement of an electronic-assisted direct-observer hand hygiene audit program. Infect Control Hosp Epidemiol 2013;34(2):207210.
17. Lankford, MG, Zembower, TR, Trick, WE, Hacek, DM, Noskin, GA, Peterson, LR. Influence of role models and hospital design on hand hygiene of healthcare workers. Emerg Infect Dis 2003;9(2):217223.
18. Haessler, S, Bhagavan, A, Kleppel, R, Hinchey, K, Visintainer, P. Getting doctors to clean their hands: lead the followers. BMJ Qual Saf 2012;21(6):499502.
19. Christakis, NA, Fowler, JH. The collective dynamics of smoking in a large social network. N Engl J Med 2008;358(21):22492258.
20. Christakis, NA, Fowler, JH. The spread of obesity in a large social network over 32 years. N Engl J Med 2007;357(4):370379.
21. Mas, A, Moretti, E. Peers at work. Am Econ Rev 2009;(1):112145.
22. Monsalve, M, Herman, T, Pemmaraju, S, Polgreen, PM, Segre, AM, Thomas, G. Inferring realistic intra-hospital contact networks using link prediction and computer logins. In: Proceedings of the 2012 International Conference on Privacy, Security, Risk and Trust (PASSAT) and 2012 International Conference on Social Computing (SocialCom); September 3–5, 2012; Amsterdam, The Netherlands. IEEE 2012.
23. Monsalve, M, Pemmaraju, S, Polgreen, PM. Interactions in an intensive care unit: experiences pre-processing sensor network data. In: Program and abstracts of the 4th Annual Wireless Health Conference; November 1–3, 2013; Baltimore, MD.
24. Polgreen, PM, Hlady, CS, Severson, MA, Segre, AM, Herman, T. Method for automated monitoring of hand hygiene adherence without radio-frequency identification. Infect Control Hosp Epidemiol 2010;31(12):12941297.
25. Fries, J, Segre, AM, Thomas, G, Herman, T, Ellingson, K, Polgreen, PM. Monitoring hand hygiene via human observers: how should we be sampling? Infect Control Hosp Epidemiol 2012;33(7):689695.
26. Hornbeck, T, Naylor, D, Segre, AM, Thomas, G, Herman, T, Polgreen, PM. Using sensor networks to study the effect of peripatetic healthcare workers on the spread of hospital-associated infections. J Infect Dis 2012;206(10):15491557.
27. Vanhems, P, Barrat, A, Cattuto, C, et al. Estimating potential infection transmission routes in hospital wards using wearable proximity sensors. PLoS One 2013;11;8(9):e73970.
28. Friggeri, A, Chelius, G, Fleury, E, Fraboulet, A, Mentré, F, Lucet, JC. Reconstructing social interactions using an unreliable wireless sensor network. Comput Commun 2010;33(12):609618.
29. Galbraith, S, Daniel, JA, Vissel, B. A study of clustered data and approaches to its analysis. J Neurosci 2010;30(32):1060110608.
30. Sharma, D, Thomas, GW, Foster, ED, et al. The precision of human-generated hand hygiene observations: a comparison of human observation with an automated monitoring system. Infect Control Hosp Epidemiol 2012;33(12):12591261.
31. Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Crit Care Med 2004;32:358363.
32. Cheng, VC, Tai, JWM, Ho, SKY, et al. Introduction of an electronic monitoring system for monitoring compliance with moments 1 and 4 of the WHO “my 5 moments for hand hygiene” methodology. BMC Infect Dis 2011;11:113.
33. Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Isolation status and voice prompts improve hand hygiene. Am J Infect Control 2007;32:358363.
34. Fisher, DA, Seetoh, T, Oh May-Lin, H, et al. Automated measures of hand hygiene compliance among healthcare workers using ultrasound: validation and a randomized controlled trial. Infect Control Hosp Epidemiol 2013;34(9):919928.
35. Duggan, JM, Hensley, S, Khuder, S, Papadimos, TJ, Jacobs, L. Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital. Infect Control Hosp Epidemiol 2008;29(6):534538.
36. Sax, H, Allegranzi, B, Chraïti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827834.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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