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Hand hygiene intervention bundles need further study
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Bundled interventions improved hand hygiene compliance, but more research is necessary to identify the ideal bundle, according to data from a systematic review and meta-analysis.
“Hand hygiene is important in preventing transmission of [health care–acquired infections],” researchers from the University of Iowa wrote in Clinical Infectious Diseases. “However, current rates of hand hygiene compliance range from 5% to 81%, with an average compliance of approximately 40%.”
The review included 46 studies of hand hygiene interventions that were published from January 2000 to April 2012. Most of the studies were quasi-experimental and conducted in either Europe or the United States. The most common study location was the ICU (n=23), followed by acute care units (n=14). Most of the studies used direct human observation to measure compliance.
In most of the studies (78%), a bundle of more than one hand hygiene intervention was assessed. The most common interventions were education, reminders, feedback and access to alcohol-based hand rub. Bundles with a larger number of interventions did not increase hand hygiene compliance compared with bundles of one or two interventions. The following bundles were associated with improved hand hygiene compliance:
- Education, reminders, feedback, administrative support and access to alcohol-based hand rub;
- Education, reminders and feedback.
“Most studies (of these two bundles) were before-after quasi-experimental studies with a single pre-intervention historical control group and single post-intervention experimental group, lacking more robust quasi-experimental methods such as inclusion of a non-equivalent control group,” the researchers wrote. “This suggests a need for investments in additional high-quality research studies of interventions targeting hand hygiene compliance.”
Disclosure: The researchers report no relevant financial disclosures.
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