Effect of multimodal intervention to enhance Hong Kong healthcare workers' hand hygiene compliance

Abstract

The purpose of this research was to develop and evaluate the process and impact of strategies to improve hand hygiene compliance in an acute hospital in Hong Kong. With reference to the results of the observation, questionnaire survey, review of literature and the small-group conference with the staff; hand hygiene program was developed, implemented and modified throughout the three cycles of action research. In the first cycle after ward-based educational talk, system change with the use of alcohol-based handrub and poster display, compliance to hand hygiene in the three experimental wards improved from 18.31% to 41.6%. However, when the hand hygiene program was extended to the whole hospital during the second cycle through provision of hospital-based educational talk and alcohol-based handrub, compliance in the control wards have no enhancement (baseline 25.4% to 25.6%) whereas the experimental wards improved steadily (44.4%). Due to poor outcome, the enhancement program was re-examined with mandatory intensive hand hygiene talk provided to all staff alongside with interventions of scenario description and immediate clarification after observation. At the end, overall compliance to hand hygiene enhanced from 22% to 54%. Additionally, the spiral process (plan, act, observe, reflect) of action research did enlighten the program coordinator that while promoting good standard practice; one should not neglect the role of supervisors, peers, infection control nurses who are significant ones in the implementation process. Furthermore, apart from changing of system in the environment to provide safety care, upholding professional values of healthcare workers is needed to sustain quality care.