Cross Infection Clinical Trial
Official title:
A Pragmatic Crossover Cluster Randomised Study of Electronic Compliance Monitoring of Staff Hand Sanitisation in Critical Care (HANDS Study)
If patients acquire a new infection whilst in hospital this can cause significant morbidity,
prolonged hospitalisation and even death. Indeed, there is much public concern about
infections such as MRSA. Patients who require intensive care are probably at the greatest
risk.
Appropriate hand hygiene by healthcare workers can reduce infection rates and is a key goal
of many patient safety initiatives. Worldwide, hand hygiene compliance has been estimated at
only 38.7% despite the intervention being simple and cheap. Reasons for poor compliance
include lack of time, skin irritation, lack of facilities, intensity of workload and
forgetfulness. Furthermore, since cross infection may not be apparent for some days, staff
may not associate their (lack of) actions with having caused harm.
Measuring compliance levels enables staff to understand whether they could improve. Direct
observation of staff is labour intensive and is not continuous or universal. We will monitor
hand hygiene compliance with a newly developed electronic system (MedSense, General Sensing
Inc.). We will use the data to provide feedback to the staff in several ways. We hypothesise
that comprehensive personalised feedback will reduce healthcare associated infections. We
will undertake the study in three intensive care units.
All patients admitted to three intensive care units will be monitored for healthcare
associated infections. In parallel the units will be cluster randomised to implement the
electronic compliance monitoring in three different ways:
- Unit level feed back every week of current compliance for each of three staff groupings
(doctors, nurses, allied health professionals)
- Personalised feedback in the form of an email at the end of a shift stating an
individuals performance relative to the average for their professional grouping.
- Real time feedback in the form of a badge worn by the healthcare worker that vibrates
when the system thinks they have missed or are about to miss an opportunity for hand
hygiene.
All healthcare workers will receive the level of feedback defined in the randomisation for
the duration of the three intervention periods. The units will cross-over with an
interventing two week wash out period.
All personal feedback will be confidential and private to the individual.
;
Observational Model: Case-Crossover, Time Perspective: Prospective
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