Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review

Abstract

OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene.

Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India

“…For example, lack of compliance with hand hygiene practices is a well-known issue for health care workers. 36 We found that birth attendants would wash hands if a coach was physically present, but when a coach was not present birth attendants performed hand hygiene on only 36% of occasions before delivery. Although hand hygiene is critical for infection prevention, 37 symptoms generally do not occur until after a mother and baby have been discharged from the facility and no longer are receiving care from the birth attendants.…”

“…For example, lack of compliance with hand hygiene practices is a well-known issue for health care workers 36 . We found that birth attendants would wash hands if a coach was physically present, but when a coach was not present birth attendants performed hand hygiene on only 36% of occasions before delivery.…”

An interventional implementation project: hand hygiene improvement

“…For the hand hygiene improvement project, we referred to the five descriptive factors for the systematic evaluation of interventional measures to formulate the implementation plan. Ensuring fidelity is crucial because it allows for the replication, evaluation, comparison, and dissemination of interventions (16)(17)(18). Implementation fidelity of an intervention has five domains: (I) adherence to the program; (II) exposure or dose (i.e., the proportion of the programme delivered); (III) quality of intervention delivery; (IV) participant responsiveness; and (V) program differentiation (i.e., the presence of distinguishing features of the intervention).…”

Improvement of hand hygiene compliance in a private hospital using the Plan-Do-Check-Act (PDCA) method

“…Healthcare staff, may be colonized with microorganisms identified as causative agents in hospital infections as a result of contact with patients and patient surroundings 3,4. Healthcare-associated infections are preventable complications in inpatients, and preventive measures are recommended as one of the most effective strategies to prevent infections 5. Many outbreaks in hospitals are usually associated with poor levels of compliance with hand hygiene 4,6.…”