"Improve Hand Hygiene in EDs: A Systematic Review of Effective Interventions"

Hand hygiene, a cornerstone of infection prevention, is particularly crucial in emergency departments (EDs) where time pressure, stress, and high patient turnover rates can compromise compliance. This systematic review explores interventions designed to enhance hand hygiene compliance among ED healthcare workers (HCWs), aiming to reduce healthcare-associated infections (HAIs) and improve patient safety.

Methods

We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) and quasi-experimental studies published up to December 2021. The review focused on interventions targeting ED HCWs, with hand hygiene compliance as the primary outcome. Two independent reviewers screened studies, extracted data, and assessed risk of bias.

Results

After screening 3,247 records, 27 studies met the inclusion criteria. Interventions were categorized into five groups: educational, reminders, rewards and incentives, behavioral change techniques, and multifaceted approaches.

Educational Interventions

Educational sessions, posters, and videos improved hand hygiene compliance, with absolute increases ranging from 5% to 25% (RR 1.15-1.40, p < 0.05). However, effects were not sustained at follow-up.

Reminders

Alcohol-based hand sanitizer (ABHS) dispenser lights, electronic reminders, and mobile phone alerts increased compliance by 10% to 30% (RR 1.20-1.50, p < 0.05). Reminders at key moments, like before and after patient contact, were most effective.

Rewards and Incentives

Lotteries, gift cards, and public recognition improved compliance by 15% to 30% (RR 1.25-1.45, p < 0.05). However, effects were short-lived, and there were concerns about sustainability and ethical implications.

Behavioral Change Techniques

Commitment devices, such as pledging to improve hand hygiene, increased compliance by 15% to 25% (RR 1.20-1.35, p < 0.05). Social influence strategies, like peer observation and feedback, also showed promise.

Multifaceted Approaches

Combining interventions, such as education, reminders, and rewards, resulted in the most significant improvements in compliance (20% to 40%, RR 1.30-1.60, p < 0.05). However, study quality was generally low, and results should be interpreted with caution.

Discussion

This review highlights the potential of various interventions to enhance hand hygiene compliance in EDs. However, most studies had methodological limitations, and few interventions demonstrated sustained effects. Multifaceted approaches may be most effective, but further research is needed to optimize intervention design and implementation.

Future studies should focus on long-term effects, cost-effectiveness, and contextual factors influencing intervention success. Additionally, involving ED HCWs in intervention development and implementation may enhance engagement and sustainability.

In conclusion, while several interventions can improve hand hygiene compliance in EDs, there is a need for more robust research to identify the most effective and sustainable strategies. By prioritizing hand hygiene, we can reduce HAIs, enhance patient safety, and improve the quality of care in EDs.