Multifaceted Hand Hygiene Interventions are Effective in Long-Term Care Facilities

Ho, et al. (2012) sought to determine the effectiveness of World Health Organization (WHO) multimodal strategy in promoting hand hygiene among healthcare workers in long-term care facilities (LTCFs). In this cluster-randomized controlled trial, 18 LTCFs in Hong Kong were randomly allocated to two intervention arms and a control arm. Direct observation of hand hygiene practice was conducted by trained nurses. Either handrubbing with alcohol-based handrub (ABHR) or handwashing with liquid soap and water was counted as a compliant action. Disease notification data during 20072010 were used to calculate incidence rate ratio (IRR).

The researchers used the WHO multimodal strategy. All LTCFs in the study were supplied with ABHR (WHO formulation I), ABHR racks, pull reels, hand hygiene posters and reminders, a health talk, video clips, training materials, and performance feedback. The only difference was that intervention arms 1 and 2 were provided with slightly powdered and powderless gloves, respectively.

A total of 11,669 hand hygiene opportunities were observed. Hand hygiene compliance increased from 27.0 percent to 60.6 percent and from 22.2 percent to 48.6 percent in intervention arms 1 and 2, respectively. Both intervention arms showed increased hand hygiene compliance after intervention compared to controls, at 21.6 percent compliance. Provision of slightly powdered versus powderless gloves did not have any significant impact on ABHR usage. Respiratory outbreaks and methicillin-resistant Staphylococcus aureus infections requiring hospital admission were reduced after intervention.

Reference: Ho M, et al. Effectiveness of Multifaceted Hand Hygiene Interventions in Long-Term Care Facilities in Hong Kong: A Cluster-Randomized Controlled Trial. Infection Control and Hospital Epidemiology. Vol. 33, No. 8; pp. 761-767. August 2012