1. METHODS INTRODUCTION RESULTS OBJECTIVES CONCLUSION METHODS FIGURES
Innovations in Behavioral Change and Patient Safety to Improve Infection Prevention and Control
- a World Health Organization ‘Clean Care is Safer Care’ Project
Yew Fong Lee 1,2, Walter Zingg1, MaryLouise McLaws3, Suraya A. Husin2,
Hock Hin Chua4, Loke Meng Ong5, See Yin Wong4, Didier Pittet1
1Institute of Global Health and Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; 2Ministry of Health, Malaysia; 3University of New South Wales, Sydney, Australia; 4Sarawak General Hospital, Kuching, Malaysia; 5Clinical Research Centre & Medical Department, Hosp. Pulau Pinang, Malaysia
METHODS
INTRODUCTION
RESULTS
Enhanced hand hygiene (HH) compliance bundled with other infection prevention practices can reduce healthcare associated infection (HCAI).
HH compliance can be as low as 40% but improvement can be achieved with multimodal strategies such as role models, feedback, peer reminders and traditional poster messages.
Sustaining improvement is difficult where  staff interact with more than one patient at a time and have limited direct contact with their supervising manager.
INTERVENTIONS
Involves 2 strategies to identify a leader of change to promote good HH practices.
Arm 1: Led by peer-identified role models.
Arm 2: Led by senior clinical role models (SCRMs), identified by management.
Control: Pre-intervention period.
PRIMARY OUTCOME MEASURES
HH compliance, measured by direct observations conducted for 56 days each during the pre-, during and post- intervention period.
OTHER OUTCOME MEASURES
Alcohol-based handrub (ABHR) usage measured by weight during the intervention period.
HH knowledge of leaders and healthcare workers (HCWs) in both wards in the pre-, during and post-intervention phases with 25 questions reported separately as % correct.
Pre- and post- intervention perception of HCWs on the impact of health care-associated infection (HCAI) and HH importance, measured on a scale with 4 nominal responses (very low to very high).
Pre- and post- intervention perception of HCWs on HH improvement measures, measured on a 7 nominal response (not effective to very effective).
QUALITY CONTROL
Auditors were trained and validated on the WHO HH gold standard auditing method.
Base on the non-parametric student t-test, HH compliance improvement in the pre-, during, & post- period by ranksum was significant in both arms (Figures 1-4).
There was negative moderate and weak correlation between the usage of ABHR and HH actions in Arm 1 (r=-0.49) and Arm 2 (r=-0.2) respectively during the intervention period.
Post amelioration assessment of HH knowledge achieved an average score of 99% for auditors, leaders and HCWs.
Perception of HCWs on the impact of HCAI and HH importance increased by 33% points in Arm 1 but remained unchanged in Arm 2.
Perception of HCWs on HH improvement measures increased by 10% points in Arm 1 while Arm 2 showed no difference.
OBJECTIVES
To examine health service issues of organizational culture change and leadership behavior in a complex environment.
To explore theories currently used to improve and sustain HH compliance. 
CONCLUSION
There was no difference between the primary outcome measure of HHC improvement between both Arms.
HCWs’ preference to hand-washing resulted in the negative correlation between ABHR usage and HH action.
METHODS
SETTING
Two acute medical wards at Sarawak General Hospital, Kuching, MY
FIGURES
Figure 1:
Pre-intervention period (Arm 1) HHC rate (%)
Figure 3:
Pre-intervention period (Arm 2) HHC rate (%)
Figure 4:
Post- intervention period (Arm 2) HHC rate (%)
Figure 2:
Post- intervention period (Arm 1) HHC rate (%)