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Background :Information about the long-term effects of hand hygiene (HH) interventions is needed. We aimed to investigate the change in HH compliance (HHC) of healthcare workers (HCWs) once a data-driven feedback intervention was stopped, and to assess if the COVID-19 pandemic influenced the HH behavior. Methods :We conducted an observational, extension trial in a surgical department between January 2019–December 2020. Doctors (n=19) and nurses (n=53) were included and their HHC was measured using an electronic HH monitoring system (EHHMS). We compared the changes in HHC during three phases: 1) Intervention (data presentation meetings), 2) Pre-pandemic follow-up and 3) Follow-up during COVID-19. Source of funding : This study was partly funded by the Danish Ministry of Health (J. no. 1608966). Conflict of interest MBH is working in Konduto ApS which has developed sani nudge TM . The other authors declare that they have no competing interests. All authors have approved the final article. Results : The HHC during phase 1 (intervention), phase 2 (pre-pandemic follow-up) and phase 3 (follow-up during COVID-19) was 58%, 46%, and 34%, respectively. Comparison analyses revealed that the HHC was significantly lower in the pre-pandemic follow-up period (46% vs 58%, P <.0001) and in the follow-up period during COVID-19 (34% vs 58%, P <.0001) compared with the intervention period (phase 1). Conclusions : Despite the COVID-19 pandemic, the HHC of the HCWs significantly decreased over time once the data presentation meetings from management stopped. This study demonstrates that HCWs fall back into old HH routines once improvement initiatives are stopped.

Background: Evidence-based practices to increase hand hygiene compliance (HHC) among health care workers are warranted. We aimed to investigate the effect of a multimodal strategy on HHC. Methods: During this 14-month prospective, observational study, an automated monitoring system was implemented in a 29-bed surgical ward. Hand hygiene opportunities and alcohol-based hand rubbing events were measured in patient and working rooms (medication, utility, storerooms, toilets). We compared baseline HHC of health care workers across periods with light-guided nudging from sensors on dispensers and data-driven performance feedback (multimodal strategy) using the Student's t test. Results: The doctors (n = 10) significantly increased their HHC in patient rooms (16% vs 42%, P< .0001) and working rooms (24% vs 78%, P= .0006) when using the multimodal strategy. The nurses (n = 26) also increased their HHC significantly from baseline in both patient rooms (27% vs 43%, P = .0005) and working rooms (39% vs 64%, P< .0001). The nurses (n = 9), who subsequently received individual performance feedback, further increased HHC, compared with the period when they received group performance feedback (patient rooms: 43% vs 55%, P< .0001 and working rooms: 64% vs 80%, P< .0001). Conclusions: HHC of doctors and nurses can be significantly improved with light-guided nudging and datadriven performance feedback using an automated hand hygiene system.

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