Kathryn Lambe1, Sinéad Lydon2,3, Jenny McSharry4, Molly Byrne4, Janet Squires5,6, Michael Power7, Christine Domegan8, Paul O'Connor3,9. 1. Health Research Board, Grattan House, 67-72 Lower Mount Street, Dublin 2, D02 H638, Ireland. 2. School of Medicine, National University of Ireland Galway, Co. Galway, H91 TK33, Ireland. 3. Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Co. Galway, H91 TK33, Ireland. 4. Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Co. Galway, H91 TK33, Ireland. 5. The University of Ottawa, Ottawa, ON, K1N 6N5, Canada. 6. The Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada. 7. National Clinical Programme for Critical Care, Clinical Strategy & Programmes Division, Health Service Executive, Dublin, D02 X236, Ireland. 8. J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Co. Galway, H91 TK33, Ireland. 9. Discipline of General Practice, National University of Ireland Galway, Co. Galway, H91 TK33, Ireland.
Abstract
Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders. Copyright:
Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders. Copyright:
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