Identifying interventions to improve hand hygiene compliance in the intensive care unit through co-design with stakeholders

Abstract

Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders.

Action research on promoting hand hygiene practices in an intensive care unit

“…The ABHR consumption remained still high in the second observation cycle and the model for ABHR trends were statistically significant. It has been shown that the ABHR availability at the point of care could influence the nurses' use of ABHR (Hansen et al, 2015 ; Lambe et al, 2021 ). Therefore, one reason for the high level of ABHR consumption in our study could be that, in this ICU, the hospital had positioned ABHR dispensers close to the patients many years prior to the study period.…”

“…Erasmus et al ( 2009 ) argued that a lack of positive role models and social norms might hinder HH compliance. Through strengthened competence, the IPLs could become role models for other personnel, which has proven to be an important issue in HH compliance (Lambe et al, 2021 ). The role of IPLs did not seem to have an influence on ABHR consumption or ICU‐HAI trends.…”

Hand Hygiene Messaging Design in the Workplace: Views From the Workforce—Introduction

“…The results above raise several issues worthy of further discussion. Only 20% of participants thought that workers should be involved in the design of health messages despite the apparent value of stakeholder input being evidenced in the literature (Jenner et al, 2005; Lambe et al,2021). These findings suggest that there may be a recruitment challenge for any researchers/organization wishing to involve members of staff in the design of HH interventions.…”

“…Lambe et al (2021), however, did conduct codesign tasks with stakeholders (including ranking and rating exercises) in a clinical setting and used findings to propose guidance for how HH initiatives can be constructed. Use of visual communication scored highly, and reprimands or coercive approaches were less favorably received.…”

“…Consultation is often used within a wider methodology to scaffold and prime an intervention trial rather than to gain attitude knowledge to share in a wider academic setting. Lambe et al (2021), however, did conduct codesign tasks with stakeholders (including ranking and rating exercises) in a clinical setting and used findings to propose guidance for how HH initiatives can be constructed. Use of visual communication scored highly, and reprimands or coercive approaches were less favorably received.…”