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The Impact of Role Models on Hand Hygiene Compliance Carolyn Dombecki, Muazzum M. Shah, Angela Eke-Usim, Sarah R. Akkina, Melissa Ahrens, Lisa Sturm, Laraine Washer and Betsy Foxman Infection Control & Hospital Epidemiology / Volume 36 / Issue 05 / May 2015, pp 610 - 612 DOI: 10.1017/ice.2015.20, Published online: 16 February 2015

Link to this article: http://journals.cambridge.org/abstract_S0899823X15000203 How to cite this article: Carolyn Dombecki, Muazzum M. Shah, Angela Eke-Usim, Sarah R. Akkina, Melissa Ahrens, Lisa Sturm, Laraine Washer and Betsy Foxman (2015). The Impact of Role Models on Hand Hygiene Compliance. Infection Control & Hospital Epidemiology, 36, pp 610-612 doi:10.1017/ice.2015.20 Request Permissions : Click here

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infection control & hospital epidemiology

may 2015, vol. 36, no. 5

Affiliations: 1. Communicable Disease Control Directorate, Western Australian Department of Health, Perth, Western Australia, Australia; 2. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; 3. School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia Address correspondence to Lauren E. Tracey, MPH, Communicable Disease Control Directorate, Western Australian Department of Health, 227 Stubbs Terrace, Shenton Park, Western Australia, 6008, Australia ([email protected]). Received August 25, 2014; accepted January 12, 2015; electronically published February 5, 2015 Infect Control Hosp Epidemiol 2015;36(5):608–610 © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3605-0022. DOI: 10.1017/ice.2015.16

definitions of role model.3,4 For example, a University of Utah study of 66 nursing students found that HH compliance was positively influenced by the HH practices of their mentors.4 However, a Northwestern University study of 721 HCWs found a negative effect. If a senior health professional did not wash his or her hands, HCWs were less likely to wash their hands. However, no change in behavior was observed if a senior health professional did wash their hands.3 In our study, we analyzed ~3,000 HH observations to describe the impact of being in a group (≥2 people) with a leader modeling HH compliance to determine whether the HH practices of HCWs in groups are influenced by the HH practices of group role models.

references methods 1. Vasilevska M, Ku J, Fisman DN. Factors associated with healthcare worker acceptance of vaccination: a systematic review and metaanalysis. Infect Control Hosp Epidemiol 2014;35:699–708. 2. Skowronski DM, Parker R, Strang R. The importance of influenza immunizations for health-care workers. BCMJ 2000;42:91–93. 3. Loulergue P, Moulin F, Vidal-Trecan G, et al. Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations. Vaccine 2009;31:4240–4243. 4. Seale H, MacIntyre CR. Seasonal influenza vaccination in Australia hospital health care workers: a review. Med J Aust 2011;195:336–338. 5. Hofmann F, Ferracin C, Marsh G, Dumas R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection 2006;34:142–147. 6. McEvoy SP. A retrospective survey of the safety of trivalent influenza vaccine among adults working in healthcare setting in south metropolitan Perth, Western Australia, in 2010. Vaccine 2012;30:2801–2804. 7. Ankrah DNA, Mantel-Teeuwisse AK, De Bruin ML, et al. Incidence of adverse events among healthcare workers following H1N1 mass immunization in Ghana. Drug Safety 2013;36: 259–266. 8. Scheifele DW, Bjornson G, Johnston J. Evaluation of adverse events after influenza vaccination in hospital personnel. CMAJ 1990;142:127–130. 9. Think With Google. Our mobile planet: understanding the mobile consumer. Data sets and country reports. 2013. http://think.with google.com/mobileplanet/en/downloads/. Accessed January 1, 2015.

The Impact of Role Models on Hand Hygiene Compliance

Proper hand hygiene (HH) is the single most important factor in preventing healthcare-associated infections (HAIs), but HH compliance rates remain alarmingly low among healthcare workers (HCWs).1,2 Social dynamics may influence HH practices, but evidence supporting an effect of role models and leadership regarding HH is limited by small samples and loose

Study Population A total of 4 adult inpatient care units at a single tertiary care hospital were selected for study: a rehabilitation unit, an intensive care unit, and 2 observation units. HH stations, defined as either a sink or an alcohol-based hand rub (ABHR), were located both inside and outside of patient rooms. Only the intensive care unit had glass windows to allow viewing of HH stations inside a patient’s room; in-room HH stations in other units were not observed (to maintain patient privacy). Units were observed between February 14 and 28, 2014, by 21 graduate students (8 hours/student). Observers were trained in the use of a standardized observation tool employed for data collection. The tool was an HH observation tool used at UMHS with modifications. Definitions Data were collected at 4 HH opportunities: room entry, room exit, before gloves were put on, and after glove removal. Glove use followed hospital policy for standard precautions or contact precautions as appropriate. Successful HH was defined as the use of soap and water or ABHR when presented with an HH opportunity. Observations were classified as “group” or “individual,” where “group” was defined as 2 or more HCWs presented with the same HH opportunity at the same time. “Individual” was defined as any nongroup observation. A “group leader” was defined as the HCW with the highest apparent seniority in the group who was considered the HH role model for that group. If no leader was apparent, the group was regarded as leaderless. Observations were further stratified by unit and HCW type based on attire, including long white coats (eg, worn by attending physicians, residents, physician assistants, nurse practitioners), short white coats (eg, worn by students), scrubs (eg, worn by nurses), and other attire (eg, worn by environmental services, dietary, transport, etc.). Analysis We calculated HH compliance, defined as the proportion of successful HH events, separately for groups and individuals.

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table 1. Comparison of Hand Hygiene (HH) Compliance in Two Scenarios: (1) When a HCW Performs HH Alone versus when a HCW Performs HH in a Group and (2) When a Group Leader Performs HH versus when a Group Leader Does Not Perform HH Total

Individuals

Groups with Leaders

Groups without Leaders

Observations, No.

Total, No.

Performed HH, No. (%)

Total, No.

Performed HH, No. (%)

Total, No.

Performed HH, No. (%)

Overall

2,936

2,668

1,296 (49)

198

105 (53)

70

40 (57)

HCW Type Long white coat Short white coat Scrubs Other

284 59 2,123 470

222 48 1946 450

93 (42) 17 (35) 1,067 (55) 119 (26)

52 11 126 9

24 (46) 3 (27) 72 (57) 6 (66)

10 0 49 11

2 (20) 0 (0) 34 (69)a 4 (36)

Unit Rehab ICU Obs unit #1 Obs unit #2

770 922 191 1,055

766 754 167 981

298 (39) 456 (60) 57 (34) 485 (49)

2 117 14 65

0 (0) 68 (60) 1 (7)a 36 (55)

0 51 9 10

0 (0) 30 (58) 3 (33) 7 (70)a

Hand Hygiene Performance in Group Members with Leaders (excluding leaders)

Leader did not perform HH Leader performed HH

Total Observations, No.

Performed HH, No. (%)

P valueb

58 62

17 (29%) 44 (71%)

The impact of role models on hand hygiene compliance.

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