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MRSA Action UK: Behavourial science increases hand hygiene compliance

Behavourial science increases hand hygiene compliance – use of soap increased by 30% in three year study of Cleanyourhands feedback intervention

The First UK Summit on Hand Hygiene Sustainability in Health Care was held on24th October 2012, in London.  The Alliance of Patients and Healthcare Workers led the Hand Hygiene Summit hosted by GovToday.

Andrea Jenkyns, Trustee of MRSA Action UK, gave her very moving presentation to a packed audience of healthcare professionals “The Way Forward; from the Patient Perspective”.

The success of the Cleanyourhands campaign, propagated in the context of a very high political focus featured at the conference.  Dr Sheldon Stone presented the findings from a major three-year trial led by researchers at University College London, in partnership with the Health Protection Agency, showing that giving one-to-one feedback to healthcare workers makes them twice as likely to clean their hands or use soap.

The Feedback Intervention Trial (FIT) is the first such trial to be done in a large number of hospitals anywhere in the world. The study was carried out across 60 wards in 16 hospitals that were already implementing the English and Welsh Cleanyourhands campaign, the study showed that an intervention that coupled feedback to personalised action planning improved hand-hygiene compliance by up to 18 per cent on Intensive Therapy Units and 13 per cent on Acute Care of the Elderly wards. It was also found that soap use increased by 30%.

It is the first trial to use behavioural sciences to change health care workers hand hygiene behaviour.

Sustained improvements in hand-hygiene are key to the World Health Organisation’s SAVES LIVES strategy to reduce health-care associated infection, yet hand-hygiene compliance amongst healthcare workers remains poor, with levels of 25-40% being common.

The study suggests that the NHS should explore using the FIT intervention and learn how best to implement it, as used properly it can be a really powerful tool. The intervention, which couples feedback to personalised action planning, could be included in infection control teams' audit and appraisal systems in order to reduce the burden of healthcare associated infection on hospital wards.

The intervention process involved a four-week audit cycle, with healthcare workers observed for 20 minutes. Immediate feedback was given after the period of observation, and the person was then helped to form a personal action plan for better hand hygiene. The more frequently wards carried out the intervention, the stronger its effect.

In addition to observing and measuring hand-hygiene compliance, the amount of soap and alcohol hand-rub used each month was also collected as another measure of hand-hygiene compliance for each ward. This also gave a better picture of the total weekly usage, as such data was not subject to any observational bias.

Although audit and feedback is often suggested as a way of improving hand hygiene, this study puts its use on a firmer footing than previous non-randomised studies, providing the strongest evidence yet that this is an effective way to improve hand hygiene when coupled with a repeating cycle of personalised goal-setting and action planning.

Andrea followed Sheldon’s presentation from the patient perspective and spoke of how the charity MRSA Action UK was formed in response to people dying and being harmed by avoidable healthcare associated infections.

Andrea’s presentation focused on behaviours and how the minor and almost subconscious actions in everyday life can have a catastrophic effect, particularly in the healthcare environment.

Andrea told the conference there should be no more faceless statistics, every hospital trust should publish photographs, with the permission of families, of those lost to healthcare associated infections in their regular newsletters. Many of our loved ones could have been saved by simple actions, she asked “Can you honestly put your hand on your heart and say over the last month you washed your hands every time that you were meant to.....?

Andrea’s presentation featured Sammie Fallon who died of MRSA aged just 17 after having a bone marrow test. Sammie’s mum said “I don’t want any other mum to go through the pain my family has”

Andrea showed a very moving slide of her Dad during happier times. The slide was all the more shocking to the conference as this was recent, and it was easy for those in healthcare to sit back and think of how far they had come in reducing the numbers of avoidable infections, but only to realise that this was still happening as hand hygiene compliance and other essential elements of infection prevention and control were not as good as they should be.

30 seconds to wash hands to save someone’s life, that’s all. Andrea asked the conference “how hard can it be?” If a child can learn effective hand hygiene, we all should be able to do this simple act.

Derek Butler
MRSA Action UK
07762 741114

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