Wednesday, October 16, 2013

Bundles for Hand Hygiene: An optimal Approach?

Bundles for infection prevention are now standard fare and include interventions to improve hand hygiene compliance. 

Here is a systematic review published in Clinical Infectious Diseases of studies to improve hand hygiene compliance. Of the 8,148 studies evaluated, six randomized controlled trials and 39 quasi-experimental studies were analyzed. 

Three studies evaluated the interventions education, reminders, feedback, administrative support, and access to alcohol-based hand rub [ABHR] as a bundle, which was associated with improved hand hygiene compliance (pooled odds ratio [OR]=1.82; 95% confidence interval [CI]=1.69, 1.97). Another bundle of education, reminders, and feedback evaluated in three studies was associated with improved compliance (pooled OR: 1.47; 95% CI: 1.12, 1.94).

So the optimal hand hygiene approach includes:
  • Hand hygiene education
  • Reminders and prompts
  • Hand hygiene compliance monitoring with feedback
  • Support (financial and administrative) to achieve and sustain the above 
And, once you put your foot on the hand hygiene compliance accelerator, coming off the gas will eventually bring the program's success to a halt. These are not one time interventions.

Sustainability is the key.

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