Individual hand hygiene improvements and effects on healthcare-associated infections: A long-term follow-up study using an electronic hand hygiene monitoring system.

BACKGROUND: Obtaining detailed insights into people's unique hand hygiene behaviour could play an important role in developing the most effective long-term hand hygiene compliance (HHC) interventions.

AIM: To investigate the effect of two feedback interventions provided by an electronic hand hygiene monitoring system (EHHMS) on sustained HHC improvement, individual responsiveness, and prevention of hospital-acquired bloodstream infections (HABSI) and urinary tract infections (HAUTI).

METHODS: The study included two two-year cohorts (exposed and unexposed to EHHMS) observed over four years in an internal medicine department with 142 caregivers and 39 doctors. Healthcare workers (HCWs) were stratified into four groups based on their baseline performance to assess predicted responsiveness to the interventions.

FINDINGS: All healthcare workers increased their HHC independently from their performance during baseline, except a few in the low-performance groups with constantly low HHC. The two low-performance groups at baseline were most responsive to group feedback (weekly change in HHC of 4.4% and 3.1%) compared to individual feedback (weekly change in HHC of 1.0% and 2.2%). The number of HABSI cases was significantly reduced during the intervention period (P=0.01), with the highest effect on Staphylococcus aureus. No significant change was observed in HAUTI.

CONCLUSION: The EHHMS interventions successfully sustained the HHC improvements and reduced the number of HABSI cases. All HCWs, except a few, responded to the interventions. The two low-performance groups during baseline never reached the same HHC levels as those in the high-performance groups, indicating a potential for further improvement and the need for intensified individualized interventions.