title: Efficacy of a new educational tool to improve Handrubbing technique amongst healthcare workers: a controlled, before-after study.
abstract: BACKGROUND
  Hand hygiene is a key component of infection control in healthcare. WHO recommends that healthcare workers perform six specific poses during each hand hygiene action. SureWash (Glanta Ltd, Dublin, Ireland) is a novel device that uses video-measurement technology and immediate feedback to teach this technique. We assessed the impact of self-directed SureWash use on healthcare worker hand hygiene technique and evaluated the device's diagnostic capacity.
  
  
  METHODS
  A controlled before-after study: subjects in Group A were exposed to the SureWash for four weeks followed by Group B for 12 weeks. Each subject's hand hygiene technique was assessed by blinded observers at baseline (T0) and following intervention periods (T1 and T2). Primary outcome was performance of a complete hand hygiene action, requiring all six poses during an action lasting ≥20 seconds. The number of poses per hand hygiene action (maximum 6) was assessed in a post-hoc analysis. SureWash's diagnostic capacity compared to human observers was assessed using ROC curve analysis.
  
  
  RESULTS
  Thirty-four and 29 healthcare workers were recruited to groups A and B, respectively. No participants performed a complete action at baseline. At T1, one Group A participant and no Group B participants performed a complete action. At baseline, the median number of poses performed per action was 2.0 and 1.0 in Groups A and B, respectively (p = 0.12). At T1, the number of poses per action was greater in Group A (post-intervention) than Group B (control): median 3.8 and 2.0, respectively (p<0.001). In Group A, the number of poses performed twelve weeks post-intervention (median 3.0) remained higher than baseline (p<0.001). The area under the ROC curves for the 6 poses ranged from 0.59 to 0.88.
  
  
  CONCLUSIONS
  While no impact on complete actions was demonstrated, SureWash significantly increased the number of poses per hand hygiene action and demonstrated good diagnostic capacity.
authors.affiliation: Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stewardson
authors.affiliation: Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Iten
authors.affiliation: Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Véronique
authors.initials: V
authors.lastname: Camus
authors.affiliation: Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Clinical Epidemiology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Angèle
authors.initials: A
authors.lastname: Gayet-Ageron
authors.affiliation: Glanta Ltd, Dublin, Ireland.
authors.forename: Darren
authors.initials: D
authors.lastname: Caulfield
authors.affiliation: Glanta Ltd, Dublin, Ireland; School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Lacey
authors.affiliation: Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000328:Adult; D065187:Controlled Before-After Studies; D005260:Female; D063373:Hand Hygiene / Q000379:methods*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D055815:Young Adult