title: Implementation of an innovative hands-on training to improve adherence to hygiene rules: A feasibility Study.
abstract: BACKGROUND
  Hospital-acquired infections (HAI) still pose a major problem in inpatient care. The single most important measure for preventing HAIs is to improve adherence to hand hygiene among health care professionals.
  
  
  OBJECTIVE
  To assess the feasibility of an innovative hands-on training to improve adherence to hygiene rules under standardized and under real life conditions.
  
  
  METHODS
  Before-after controlled cohort trial to assess the feasibility of implementing an innovative hands-on training to improve hand hygiene adherence.
  
  
  METHODS
  Large university hospital in Germany.
  
  
  METHODS
  Fifty trained nurses from three wards with an average age of 32years (±10.22years) and an average vocational experience of 6.85years (±7.54years).
  
  
  METHODS
  The intervention consisted of a hands-on training in the skills lab of the University of Cologne complemented by a 12-week observation period before and after the training on participating wards. The training comprised important skills with respect to hand hygiene, venipuncture, dressing changes of central venous catheters, preparation of IV infusions, and donning of gloves using sterile technique. A communication training was included to enable nurses to enforce hygiene rules in their collaboration with peers and physicians. The intervention was taught in small groups with a wide array of interactive teaching methods. It was evaluated using the objective structured clinical examination (OSCE) format. Observations were conducted by a trained infection control nurse.
  
  
  RESULTS
  Before (after) the intervention 622 (612) occasions of hand hygiene were documented. A highly significant improvement in hygiene compliance was observed pre- and post-intervention (64.3% vs. 79.2%; p≤0.0001). The OSCE evaluation showed significant improvements in all subscales.
  
  
  CONCLUSIONS
  The developed and conducted hands-on training seems feasible and is successful in significantly improving adherence to hygiene rules under standardized and real life conditions. Whether the effect is stable over time is subject to further investigation.
authors.affiliation: Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Strasse 176-178/II, 50935 Koeln/Cologne, Germany. Electronic address: stephanie.stock@uk-koeln.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.affiliation: Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Strasse 176-178/II, 50935 Koeln/Cologne, Germany. Electronic address: ralf.tebest@uk-koeln.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Tebest
authors.affiliation: Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Strasse 176-178/II, 50935 Koeln/Cologne, Germany. Electronic address: kristina.westermann@uk-koeln.de.
authors.forename: Kristina
authors.initials: K
authors.lastname: Westermann
authors.affiliation: Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Strasse 176-178/II, 50935 Koeln/Cologne, Germany. Electronic address: christina.samel@uk-koeln.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Samel
authors.affiliation: Administrative Department of Nursing Science, The University Hospital of Cologne (AöR), 50935 Koeln/Cologne, Germany. Electronic address: barbara.strohbuecker@uk-koeln.de.
authors.forename: Barbara
authors.initials: B
authors.lastname: Strohbücker
authors.affiliation: Office of the Dean of Studies, Medical Faculty of the University of Cologne, Koeln/Cologne, 50923, Germany. Electronic address: christoph.stosch@uk-koeln.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stosch
authors.affiliation: Public Health Office of the Rhein-Sieg district, Kaiser-Wilhelm Platz 1, 53721 Siegburg, Germany. Electronic address: hans-martin.wenchel@rhein-sieg-kreis.de.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Wenchel
authors.affiliation: Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Strasse 176-178/II, 50935 Koeln/Cologne, Germany; Institute of General Practice, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany. Electronic address: marcus.redaelli@uk-koeln.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Redaèlli
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005240:Feasibility Studies; D005858:Germany; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D015397:Program Evaluation; D055815:Young Adult
keywords: Hand hygiene; Hospital-acquired infection; Hygiene education; Hygiene guidelines; Objective structured clinical examination